Case One

357900
8

A 62 year old man presents to clinic for routine follow up. He has a history of diabetes (HbA1c 7.5%), hypertension, and hyperlipidemia. Current medications are metformin, hydrochlorothiazide, and atorvastatin. He consumes 1-2 alcoholic beverages weekly.

On physical exam, blood pressure 152/80 mmHg, BMI is 36. Labs are notable for alkaline phosphatase of 180 u/L, ALT 64 u/L, and AST 42 u/L. Platelet count is 250,000 and hemoglobin is 13. Ultrasound shows a normal gallbladder without stones, normal bile ducts, and an enlarged, echogenic liver.

You send a smear, which shows the following.