Fatty liver with elevated transaminase levels due to heterozygous apolipoprotein B deficiency

Elevation of transaminase levels in asymptomatic subjects could be due to a common benign condition such as fatty liver or a more serious disease such as chronic hepatitis due to various causes; in some subjects a liver biopsy is indicated. Heterozygous apolipoprotein B deficiency is an uncommon cause of transaminase elevation, as indicated by low levels of cholesterol and low density lipoprotein-cholesterol. This should be noted to avoid unnecessary investigations (including liver biopsy) in asymptomatic subjects with persistent elevation of transminase levels in the serum.