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Hi Doctor. Basically, physical complaints started in Nov., 2008.  It began with a respiratory infection that was treated with Levaquin.  The respiratory infection eventually cleared, however, in the process I began to develop more concerning symptoms.  Primarily, my symptoms have been severe loss of appetite, occasional night sweats, ache in upper right abdomen and a lightheaded foggy feeling.

I've had extensive testing done by my primary physician, and most recently at the Mayo Clinic in Rochester, MN.  The doctors at mayo discovered via abdomen ct scan that I had inflammed chest/abdomen lymph nodes.  Additionally they said I had the following abnormal blood test results:

WBC: 13.5
Alkaline Phosphatase: 134
C-reactive Protein: 10.9
GGT: 67
Cholesteral 255

At mayo I had abd. ultrasound (normal), chest xray(normal), colonoscopy (normal) and pet scan (no uptake in lymph nodes)

Although I have abstained from alcohol since 2006, I do have a history of drinking moderate/heavy during different time periods in the past.  I was denied life insurance in 2006 because of elevated ggt (143).

Ultimately, my question is....given my symptoms, lab abnormalities, history of alcohol consumption and risk exposure, is it possible that I have an undiagnosed problem with liver (cirhossis) despite normal imaging?  Mayo Drs. said I definitely had an inflammatory process going on but said it was from an undetermined cause and that it was unlikely to be the liver.  They ruled out many things, but isn't it true that liver disorders can present as normal and only be truly diagnosed via biopsy?  Throughout this whole process the liver has been my only concern because of my history.  Mayo drs. said that time will lead them to a more conclusive diagnosis.  I'm scheduled to go back in October.  Meanwhile, they prescribed me lipitor for cholesteral which I'm scared to take for fear that I will further insult my liver.

I would greatly appreciate any thoughts or ideas on what to do next.

[Kevin Pho, MD]

You clearly have had a comprehensive evaluation, including one at the Mayo Clinic.  Keep in mind that it's unlikely that I will be able to come up with something new over the Internet without examining you.

If cirrhosis is a concern, the definitive test would be a liver biopsy.  But, if the ultrasound was normal, that is suggestive that cirrhosis is an unlikely possibility.

The lymph nodes can be concerning for cancer, but again, a negative PET scan would again make that less likely.  

In the end, I can't think any further tests that would be helpful at this point.  Perhaps serially monitoring the liver enzymes so that they do not rise can be done, but as for imaging studies, you have been comprehensively examined.  

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 Pho, M.D.

KevinMD.com
Twitter.com/kevinmd