An Unexpected Cause of Severe Steatohepatitis in a Young Male

Question A 24-year-old male with a body mass index (BMI) of 37.4 kg/m2 was referred to our hospital following the incidental discovery of abnormal liver echogenicity on a routine physical examination. The patient denied any history of alcohol consumption or illicit drug use and reported no family history of liver or metabolic diseases. Abdominal ultrasonography performed in December 2025 revealed heterogeneous liver echotexture with diffuse nodular hyperechoic areas, initially suggestive of nodular fatty infiltration or cirrhosis, and was accompanied by mild splenomegaly. Contrast-enhanced abdominal computed tomography (CT) demonstrated the following findings (Figure A).