Differential Diagnosis for 60 YO F with Elevated Liver Enzymes

Single Most Likely Diagnosis

• Non-Alcoholic Fatty Liver Disease (NAFLD): Given the patient's fibroscan result of F0 (indicating no significant fibrosis), elevated AST and ALT levels, and high iron saturation without other clear causes of liver injury, NAFLD is a plausible diagnosis. The improvement in platelet count could be incidental or related to variations in measurement.

Other Likely Diagnoses

• Drug-Induced Liver Injury (DILI): The patient is taking topiramate and gabapentin. While these medications are less commonly associated with liver injury, DILI should be considered, especially given the recent change in liver enzymes.
• Hemochromatosis: Although the iron saturation is high, the diagnosis of hemochromatosis typically requires genetic confirmation and more pronounced iron overload symptoms. However, it's a consideration given the elevated iron levels.
• Steatohepatitis (NASH): A subset of NAFLD, NASH involves inflammation and damage to liver cells. It could explain the elevated liver enzymes but would typically require a liver biopsy for definitive diagnosis.

Do Not Miss Diagnoses

• Autoimmune Hepatitis: Despite normal autoimmune and hepatitis panels, autoimmune hepatitis can sometimes present with atypical serologies. If suspected, one would expect to see elevated levels of certain autoantibodies (e.g., ANA, anti-smooth muscle antibodies), increased IgG levels, and interface hepatitis on liver biopsy.
• Wilson's Disease: Although rare and more commonly diagnosed in younger individuals, Wilson's disease (a genetic disorder leading to copper accumulation in the liver) can present with elevated liver enzymes and requires consideration to avoid missing this potentially treatable condition.

Rare Diagnoses

• Alpha-1 Antitrypsin Deficiency: A genetic disorder that may cause liver disease and lung disease, it's less likely given the patient's age and presentation but should be considered in the differential diagnosis of liver enzyme elevations.
• Primary Biliary Cholangitis (PBC): An autoimmune disease of the liver characterized by progressive destruction of the bile ducts within the liver. It's less likely given the normal autoimmune panel but could be considered if other symptoms suggestive of PBC are present (e.g., pruritus, fatigue).