Isolated and Persistent Gamma-Glutamyl Transferase Elevation and Porto-Sinusoidal Vascular Disorder Diagnosis

Abstract

Porto-sinusoidal vascular disorder (PSVD) is a distinct clinical entity often presenting with heterogeneous symptoms, from asymptomatic to complications of portal hypertension. This case report describes a 62-year-old male with a 30-year history of isolated elevated gamma-glutamyl transferase (GGT) without a clear cause after extensive evaluation. Despite the absence of liver disease stigmata or portal hypertension, persistent elevated GGT led to a liver biopsy, which confirmed the diagnosis of PSVD. This case underlines the importance of further investigation in patients with isolated and persistent elevated GGT, especially in males with low liver stiffness values (<10 kPa), as PSVD may be underdiagnosed. It emphasizes that isolated GGT elevation, typically overlooked without evidence of liver disease progression, should prompt additional diagnostic measures. Recognition of PSVD can lead to proper prognosis and monitoring, highlighting the requirement for liver biopsy to ensure accurate diagnosis.