Metabolic dysfunction-associated steatotic liver disease with alcohol- and iron overload-related cholestatic liver injury: a case report.

A 38-year-old woman with a >10-year history of heavy alcohol consumption presented with acute-onset jaundice and massive hepatomegaly. Laboratory tests revealed a cholestatic-pre-dominant liver injury pattern with extreme γ-glutamyl transferase elevation (>1,000 U/L) and marked hyperferritinemia (>1,500 ng/ml). Imaging excluded extrahepatic biliary obstruction. Liver biopsy demonstrated steatohepatitis with ductular reaction and stage F2 fibrosis. Metagenomic next-generation sequencing (mNGS) was negative for infectious pathogens. After alcohol abstinence, metabolic intervention, a short empiric corticosteroid course, and supportive therapy, liver function gradually improved. This case highlights a reversible cholestatic phenotype in alcohol-associated steatotic liver injury with metabolic dysfunction and suspected secondary iron overload.