Abstract

Question: A 76-year-old man with no medical history developed morning stiffness and finger and foot pain, which were accompanied by bilateral edema of the hands and feet. Blood examination revealed a slightly elevated white blood cell count (9100 cells/μL) and normal red blood cell and platelet counts. Biochemical analyses showed a marked elevation of serum aspartate transaminase (237 U/L; normal range [NR] 13–30 U/L) and alanine transaminase (239 U/L; NR 10–42 U/L), whereas total bilirubin and γ-glutamyl transpeptidase levels were normal.

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