An unusual case of markedly elevated AFP in a case of decompensated cirrhosis without HCC

Background and Aim: Alpha fetoprotein is a fetal specific glycoprotein normally produced during gestation by liver yolk sac. Apart from HCC, Elevated levels of AFP in Cirrhosis can be seen acute chronic viral hepatitis. However, > 400 ng/ml cirrhotic highly suspicious HCC. We present case decompensated cirrhosis with portal vein thrombosis (PVT) having markedly elevated without evidence Case report: A 67-year-old male, known T2 DM presented abdominal distension pain abdomen for 2 weeks. There was no history hematemesis or melena. He teetotaler. Physical examination revealed pallor, distended shifting dullness. Laboratory evaluation hypoalbuminemia mild anemia. Ultrasound showed features liver, moderate ascites. Ascitic fluid analysis High SAAG, low protein SBP atypical cells. EGD Large esophageal varices RWS. EVL done. Serum sent view Acute PVT 1210 ng/ml. Triphasic CT focal lesion suggestive USG guided biopsy An etiological workup negative Hepatitis B C serology, HbeAg negative, Total Anti-Hbc HBV DNA not detected. probable diagnosis due to NASH made. started on anticoagulation LMWH. Conclusion: Significant elevations patient the absence radiological histological HCC challenging clinicians. Whether cause marked elevation such patients well understood documented only few isolated reports.