An Interesting Case of Hepatomegaly

Question: A 65-year-old man was referred to our center with a 6-month history of progressive shortness of breath, unintentional weight loss (31 kg during the last 6 months), and night sweats. Past medical history included previous alcohol misuse. He was a nonsmoker with no significant family history. Physical examination revealed a cachectic man with hepatomegaly. He had no ascites, no jaundice, and no stigmata of chronic liver disease. Notable laboratory test results included a y-glutamyl transferase 219 IU/L (reference range, 12–68 IU/L) and alkaline phosphatase 194 IU/L (reference range, 30–130 IU/L), with a normal liver profile otherwise. He was coagulopathic with an international normalized ratio of 1.58 and anemic with a hemoglobin level of 10.8 g/dL (reference range, 13–17 g/dL). Brain natriuretic peptide was elevated at 6389 pg/mL (reference range, <250 pg/mL). Renal function, tumor markers, lactate dehydrogenase, and viral and autoimmune screens were negative.