He is 5 feet 7 inches tall and weighs 250 pounds. Physical examination is unremarkable. He is not taking any medications except ibuprofen for headache. He has diet-controlled diabetes mellitus. He denies blood transfusions, intravenous drug use, or multiple sexual partners.
Genetic hemochromatosis is a likely diagnosis.
The fact that his ALT is twice his AST suggests that in spite of his denial he may have alcoholic liver disease. Testing for hepatitis B and C would have low yield in view of the absence of risk factors. The liver enzymes suggest a hepatocellular process rather than a biliary process. Ibuprofen is unlikely to be the cause of his liver enzyme elevation, as it usually causes more of a cholestatic picture. Repeat testing in 3-4 months will most likely show normal levels of liver enzymes.