A 42-Year-Old Man Comes to the Office for a Routine

A 42-year-old man comes to the office for a routine medical evaluation.  He has no known medical conditions but has not seen a health care provider in many years.  The patient has had an intermittent, nonproductive cough and otherwise feels well.  He takes no medications, drinks alcohol occasionally, and does not use tobacco or illicit drugs.  Vital signs are within normal limits.  Physical examination shows no scleral icterus or mucosal pallor.  The lungs are clear on auscultation and heart sounds are normal.  The liver edge is palpable 3 cm below the right costal margin, and the spleen tip is palpable below the left costal margin.  There is no skin rash or extremity edema.  Laboratory results are as follows: Chest x-ray shows mediastinal fullness and bilateral reticulonodular opacities, mostly involving the upper lungs.  Which of the following is the most likely underlying cause of this patient's liver disease?

A) Excessive gastrointestinal iron absorption
B) Extracellular fibrillar protein deposition
C) Immune-mediated bile duct destruction
D) Inherited alpha-1-antitrypsin deficiency
E) Systemic granulomatous inflammation

Correct Answer:

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