An 18-year-old male receiving methotrexate for palmoplantar psoriasis was incidentally detected to have isolated indirect hyperbilirubinemia during routine follow-up. The absence of hemolysis and the presence of only minimal ultrasonographic changes in the form of grade I fatty liver warranted further evaluation. Biochemical investigations demonstrated reduced serum ceruloplasmin levels and increased hepatic copper concentration, leading to the diagnosis of Wilson’s disease despite the absence of classical clinical manifestations. The patient was initiated on zinc acetate along with ursodeoxycholic acid and was placed under continued neurological surveillance. This case highlights the importance of a systematic diagnostic approach when interpreting abnormal liver function parameters in young patients undergoing long-term immunosuppressive therapy. Written informed consent was obtained from the patient for publication of this case report.
1*Anne S. Chenkal, 2Dr. Vijay Narayanan, 3Dr. Maneesha M.S. (Sun,) studied this question.