A 33-year-old woman with well-controlled hypertension and body mass index of 21 (calculated as weight in kilograms divided by height in meters squared) presented to primary care for follow-up. Routine laboratory tests showed a newly elevated aspartate aminotransferase (AST) level of 168 U/L and alanine aminotransferase (ALT) level of 78 U/L (to convert AST and ALT to μkat/L, multiply by 0.0167). Tests 4 days later showed an AST level of 97 U/L, ALT level of 62 U/L, low-density lipoprotein cholesterol level of 99 mg/dL (to convert to mmol/L, multiply by 0.0259), and hemoglobin A1c value of 4.7% (to convert to proportion of total hemoglobin, multiply by 0.01). She reported drinking 2 alcoholic beverages per month and denied new medications or supplements. Further evaluation over 2 weeks was negative for hemochromatosis and viral and autoimmune causes. Ultrasonography showed fatty infiltration. Elastography demonstrated minimal to no fibrosis with severe hepatic steatosis. She underwent a liver biopsy for diagnostic clarity 1 week later, which was complicated by intrahepatic arterial bleeding requiring embolization with multiple follow-up visits for pain and infections. Pathology was consistent with nonalcoholic fatty liver disease (NAFLD). Further history-taking revealed polycystic ovary syndrome as a risk factor for NAFLD.