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elevated alt , positive ana, virus
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elevated alt , positive ana, virus

I have an elevated alt and positive ana after a strange virus that me and my kids had. My doc is worried about liver disease b/c of my previous history.

My history- 33 yo F three preg. Last preg, cholestasis of preg dx at 39wks, induction (5/11/02)at 6 wk checkup LFT norm

Progesterone only pill for BC then 1/04 got preg on it, miscarriage 1/30/04 b/c had fever midwife sent me to hospital. ER sonogram missed ectopic preg, said normal miscarriage instructed to go back on mini pill, bleeding stopped <1 wk, 2/28/04 severe pain, ruptured ectopic/surgery  

April/ 04- slight itching on a Friday (like w/ icp) doc told to stop minipill make appt.  Itching stopped right away but looking back maybe I was just itching b/c of allergies- I was very hyper sensitive about my health then due to recent ectopic ordeal.  On Monday LFT taken.  All norm but slight bilirubin elevation.  Retaken 1 mo. later all norm.  Normal upper right ultrasound normal. I asked if bilirubin could have been raised b/c of massive internal bleeding 2 months prior.  She said no.

one month ago- went to doc for strange virus (feel well now) fatigue, nausea, no appetite, reflux, intermittent low grade fever, itching all over with hive like (but not raised ) rash, lymph node on back of head tender and enlarged (finally going down now).  While there asked doc about possibilty of going back on bc pill so baseline LFT ordered.  ALT of 96 everything else WNL.  More blood work done 2 weeks ago.  ALT now only couple of pts above norm (should have asked about exact #)again everything else WNL.  Hep A, B, C all neg, ASMA neg  ANA postive. Doc wants to repeat LFT in 1 month. She said elevated ALT and + ANA can't be from virus and said ultrasound would have shown fatty liver (I have a BMI of 30 and just lost 8 lbs! (wt loss prog) in the last 6 weeks). I take no meds.

My children have had the same virus for 3 weeks now with my oldest son having joint aches and much more severe rash and GI symptoms than sibs.  This son has had reactive arthritis from strep before. Ped felt son has arthritic reaction to the virus and that it was most consistent with Fifth's disease  but maybe even mono.  She also said that a virus can cause +_ANA especially w/ adult women and Fifths and that ALT can elevate w/ a virus.

My doc has me scared to death of some bad autoimmune liver disease but I don't think that my labs are very suggestive of it.  Could the virus be to blame?  I know that there is a very weak assoc between ICP and PBC (PBC that looks like ICP but labs don't normalize postparum) but my labs came right back down after preg and I have never had an elevated alkaline phospatase since. Should any other tests be suggested?  Should I be concerned about liver disease?  Concerned Mom
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Tough to say without knowing what kind of virus was present.  With a positive ANA, many rheumatological diseases are present.  If you are concerned about PBC, you may want to consider obtaining an anti-mitochondrial antibody.  This test can detect the disease with approximately 95 percent sensitivity and specificity.  

If the ALT returns to normal (or just above), it may be reasonable to serially monitor it with periodic liver function checks and then do further testing if the ALT rises.  Thus, what your doctor is doing is reasonable.  

If the antimitochondrial antibody test is positive, then a liver biopsy should be considered for a more definitive diagnosis of PBC.  

This option can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b
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