# Investigation of Markedly Elevated Liver Enzymes With Serendipitous Underlying Wilson’s Disease With Chronic Alcohol Abuse

## TL;DR

A patient with a history of heavy alcohol use and high liver enzymes was found to also have Wilson's disease, highlighting the need for broad diagnostic approaches in similar cases.

## Contribution

This case highlights Wilson's disease as a potentially masked cause of acute hepatitis in patients with overlapping risk factors like alcohol abuse.

## Key findings

- A patient with chronic alcohol abuse and elevated liver enzymes was found to have Wilson's disease.
- Wilson's disease can present alongside or mask other causes of acute hepatitis.
- Clinicians should consider Wilson's disease in a broad differential diagnosis for acute hepatitis.

## Abstract

Acute hepatitis can result from a wide variety of noninfectious causes that include, but are not limited to, drugs (drug-induced hepatitis), alcohol (alcoholic hepatitis), immunologic (autoimmune hepatitis, primary biliary cholangitis), or as a result of indirect insult secondary to biliary tract dysfunction (cholestatic hepatitis), pregnancy-related liver dysfunction, shock, or metastatic disease. In clinical settings, these causes are not uncommon to overlap with each other or are masked by obviously visible causes in medical history. We reported our scenario of a patient who has a heavy history of alcohol use and presented with alcohol withdrawal symptoms and a marked elevation of liver enzymes. Interestingly, further investigations suggested Wilson's disease could be an underlying culprit of acute hepatitis in this patient. This case again emphasized that Wilson's disease can be masked under multiple causes and various scenarios, which alerts clinicians that a broad approach should be made for every case of acute hepatitis.