She presented with pyoderma gangrenosum and upon workup, her liver enzymes and bilirubin were elevated (AST, 124 IU/L; alkaline phosphatase, 410 IU/L; albumin, 3.8 g/dL; total bilirubin, 3.8 mg/dL), and liver biopsy (Fig. 2G) demonstrated pre-cirrhotic chronic cholestatic liver disease with a differential diagnosis of primary sclerosing cholangitis or a sclerosing cholangitis secondary to autoimmune hepatitis. Here, ALB is linked to pyoderma gangrenosum.