This article presents a case report of a 41-year-old male firefighter with cholecystitis and a history of mildly elevated alanine aminotransferase. Liver biopsy showed periodic acid Schiff-positive, diastase-resistant periportal globules. Retrospective review of clinical data revealed progressive lung function decline despite absent pulmonary symptoms and normal pulmonary function testing. The following disorders should be considered in any patient with elevated transaminases without an apparent etiology: viral hepatitides, medication toxicity, autoimmune hepatitis, alcohol-induced hepatic injury, and alpha-1-antitrypsin deficiency.
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