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Some signs and symptoms are only described in a few case reports, and include peripheral neuropathy involving both upper and lower limbs, mild developmental delay, anemia, respiratory distress and proximal muscle weakness [65,66,67]

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The histopathological hallmarks of ALD include steatosis, hepatocyte ballooning, and neutrophil infiltration (Stickel et al., 2017), mirrored biochemically by elevated serum transaminases, dyslipidemia, diminished antioxidant enzyme activities, and increased pro-inflammatory cytokines (Li et al., 2025)