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Autoimmune Hepatitis in 9 Year-old Girl?
Hello,

I have a 9 year-old daughter suffering from Alopecia Areata, which is rapidly progressing to Alopecia Universalis.

I've just done lab work to check for Celiac (negative) and other things like Vit D deficiency (yes), iron deficiency (no) and such.  

The results came back mostly normal.  However, her Eosinophils (rel.) were at 8.5% and (abs.) at .54 G/l while her ALT levels are at 42.  Now the lab puts the upper limit at 40 but I've read that a little girl should be under 19.  The pediatrician wanted to check daughter for worms as there has been no recent infection and no allergies, but I noticed another less common reason for the eosinophils can be cirrhosis.  That seems like a funny coincidence to me.  I know doctors don't appreciate parents doing their own research but I'm worried -- and have often had to see several docs to get a proper diagnosis (my own endometriosis comes to mind as an example).

Any thoughts on those ALT levels would be appreciated.
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1756321 tn?1499064984
I have autoimmune pernicious anaemia, Hashimoto's thyroiditis, vitiligo, and alopecia areta. I had vitamin D deficiency as well. This deficiency is extremely common with autoimmune diseases. I had elevated liver enzymes due to untreated Hashimoto's thyroiditis. This is something to consider since alopecia areata is most frequently associated with thyroid disease.

Excerpts from the study Alopecia Areta and Autoimmunity: A Clinical Study - Indian J Dermatol. 2008; 53(2): 70–74....

"Alopecia areata frequently occurs in association with other autoimmune disorders such as vitiligo, lichen planus, morphea, lichen sclerosus et atrophicus, pemphigus foliaceus, atopic dermatitis, Hashimoto's thyroiditis, hypothyroidism, endemic goiter, Addison's disease, pernicious anemia, lupus erythematosus, diabetes mellitus, Down's syndrome and others."

"One of the main systemic associations of autoimmune disease is with thyroid abnormalities. The incidence of thyroid disease has varied from 8 to 28% in patients with AA."

Excerpt from the study "Association between hypereosinophilia and alopecia" by D.H. Jones, T.J. Craig - Journal of Allergy and Clinical Immunology...

"Conclusion

Although there have been some reports concerning the association of eosinophilia and AA, the cases noted suggest that alopecia may be a presenting symptom in idiopathic hypereosinophilia."
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1530171 tn?1448133193
Hi SpalvaLit.

I'm sorry your daughter is going through this.

You got some good information from Red_Star.

A couple more things to consider.

Going beyond celiac's testing ----Grains/carbs/gluten intolerance---

Look into Gliadin test (urine), by Cyrex labs. They test 12 forms-not just the alpha ordered by most doctors- of gliadins regarding gluten intolerance (not necessarily digestive).
Now they can also test which part of the body is affected!
Most hypothyroid sufferers have gluten intolerance and don't even know it!
The gluten molecules-mainly from gmo grains- resemble the TPO(Thyroid Peroxidase - an enzyme necessary for the signalling Thyroid hormone production) molecules and thus the immune system in its response against gluten, attacks the TPO in the Thyroid also!

Researchers have looked at vitamin D levels and how they correlated with the presence of the antibody TPO-Ab.
Presence of TPO-Ab signals that the body has or has had an attack on the thyroid.
What they found is that people who were deficient in vitamin D were much more likely to have TPO-Ab positive tests.

The vitamin D receptor (VDR) is expressed in most cells and tissues of the body, including the skin  and scalp.
Studies of people lacking these functional receptors have demonstrated that absence of the VDR leads to the development of alopecia.
The Hair loss may be an early warning that one is at risk of other conditions linked to a deficiency of vitamin D.

-- Issues with Vitamin D absorption, assimilation & resistance to vitamin D---

--General Inflammation and G/I inflammation(very common with low thyroid or low adrenal sufferers) Leaky Gut Syndrome, Crohn's, Colitis. etc.
-- Low fat diet or issues with fat digestion,  also relating to not enough cholesterol  levles/production for adequate hormonal AND vitamin D synthesis ( Vit. D is fat soluble)
-- Obesity
-- Certain drugs
-- High Cortisol
-- Vitamin D Receptor (VDR) gene mutation  ( genetic /autoimmune) or decreased VDR expression, common with Hypothyroid & Hashimoto's sufferers also.
In these cases, need increased levels of D, above and beyond recommended normal serum levels, for optimum function.

The vitamin D3 deficiency must be addressed immediately to my opinion,
while  investigating hypothyroidism/Hashimoto's, gluten intolerance and
other suspected underlying imbalances & issues.

Best wishes to you and your daughter and please keep us posted.

Niko

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I have a related AI disease to your daughters, PSC, and I'm ANA positive as well with other secondary AI disorders. I've dealt with Alopecia Universalis a couple of times. They couldn't pin it down on anything in particular, thyroid or otherwise, but I had severe vit-d deficiency and severe anemia as well. As my health improves, the alopecia goes away.

Let's hope your daughter responds as well now that she can receive treatment. Just be sure to track everything so that it makes it simplier to identify what's really at play here.

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Thanks for the input everyone.  Very sorry to have disappeared.  We went on holiday right after I posed the question, then I got busy with more information received on tests.  Over the break we learned that daughter had zero detectable mannose-binding lectin (MBL).  Doctors are saying there's no causal relationship between this and the AU (it's now universalis).  
A specialist contacted through the Immune Deficiency Foundation told us to focus on the AU and to consult with a rheumatologist as well as a derm.  We saw the derm yesterday, but we refuse to allow our daughter to undergo systemic corticosteroid treatment as she started with Ophiasis, so it doesn't seem worth the possible side effects.  
Does anyone see the point of seeing a rheumatologist for all this?  Will that kind of doctor be more curious about underlying causes/possible other AIs like thyroid disorder?
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I'm looking at the lab results and see that the Gliadin tests were done and were normal, Tt glutaminase as well.  The thyroid tests done -- as far as I can see in German -- were TSH, FT3, FT4, thyreoglobulin all normal.  Looks like no TPO was done.  There are others whose translations I would need to look up, but it looks like everything was done thoroughly.
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Has there been anything chronically unusual in her bowel movements? Crazy things can happen due to the various malabsortion issue should some type of IBD be present. They can also cause secondary liver insults as well. Just a thought.
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Hi,

Not that I know of.  She always had tummy aches, which is why we initially went to the doctor back when she was 6 and had just the one little patch in the back of the head.  We thought, "okay, maybe there's a connection between this hair loss and the tummy aches."  She complained of tummy aches regularly until I took her again to the doctor this past December and had all the labs run for Celiac.  Somehow, since that day she hasn't complained of a single tummy ache.  (I really think she would if she was really having them)  So I really can't tell if it was psychosomatic or if she realised it was just hunger pangs or what.
The secondary liver insult has me worried because of the mildly elevated ALT.  But nobody seems concerned about that besides me.  If you read around, a girl her age should really have only 18 ALT and she has 42.
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I wouldn't worry too much about that, just note it like you've done. Mild elevations can happen for any number of reasons. It's when they become chronic that you need to engage a more through diagnostic effort. If she still shows elevations in 6 months or so, make sure to poke the doctors if they are still unmotivated. Let's hope.it's nothing.
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Ok, thanks.  It's great just to get stuff out there and exchange with someone, anyone, you know?  Otherwise, it just stays in one's head!  For now, my daughter is a healthy, happy girl who still bounds out of school with a huge grin on her face!
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