Liver Biopsy

[blw]

I am a 45 year old female with a hx of Sarcoidosis for 11 years. I have been on Methotrexate for the same amount of time.  For the last year my FLTs have been slightly abnormal then two months ago the were in the low 400 range. A CT showed left lobe inflammation.  More lab tests: hep tests all negative, Ferritin normal, Mitochrondrial M2AbIgG, ARUP normal, F-Actin 106f, Smooth Muscle titer 1:20, Select Antigen grater than 127, ANA positive, Hep 2 cells 20. Had liver biopsy that stated: distortion of architecture by bands of fibrosis containing chronic inflammation and ductular proliferation.  Some intraloular bile ducts show lymphocytic infiltration, one non-necrotizing epithelioid granduloma associated with a portal tract.  Numerous plasma cells are found especially along limiting plates and interface zones.  My LFTs have come down to Alkaline Phos of 94, ALT of 86, AST 74, GGT 174 as of 12/26/06. They do not think it is the medication, I do not drink and everything else is fine.  I am seeing a liver MD 2/12/06.

I do not understand the results of the biopsy,what could this all mean?

[Kevin Pho, MD]

The liver biopsy does not show cirrhosis, but does show fibrosis and inflammation.  If this continues, this can lead to cirrhosis (liver failure) in the future.  

As for the cause, this can have many causes.  This can include some of the medications you are taking.  Autoimmune causes (with a positive ANA) can also lead to this finding.  

These options can be discussed with the liver specialist you are schedule to see.

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.
kevinmd_

[lizziecee]

Hi - I don't have sarcoidosis, but I have had Crohn's for some 35 yrs, since I was 24 yrs old, when little was known about this orphan disease. I spent some 28 yrs on prednisolone.By the way, I live in England, which is so far behind the US in meds.

Some 8 yrs ago I found on the internet that methotrexate could be used as an immuno-suppressant for Crohn's - got my gastro to presribe it, even though it was off licence, and I was so well. Unfortunately, I then got breast cancer and my initial Oncologist said I had to discontinue it in order to take FEC chemo for bc, otherwise I would die of septiceamia.  An horrendous 4 months followed when I survived on hospital prescribed Frutijuice nutritional juice and lost some 28 lbs, but survived bc! Was even faecally incontinent in the street a few times, which was so humiliating that I became housebound except for my hospital appointments.

I went back onto mtx after I finished FEC chemo, but my gastro, a brilliant guy, is worried about the toxic effects of mtx on my liver. I have monthly blood tests and they are fine! He has talked about a liver biopsy but said it is very invasive and he is not happy to do it at this time as my blood tests are good.

I drink, perhaps, too much wine, about 4 glasses a night, but still my liver function tests are fine. I guess I must get a break some times with these life threatening diseases! And, as long as my blood tests are fine, I shall continue.

If my blood tests showed high ALTs and AST's I would be very concerned, as is the doctor on this forum.

For me, mtx has been a life saver, and I feel very fortunate that my metabolism can take it.

I hope you can get sorted out.
Liz.

[Horseyear]

I have been tested HBsAg Positive; Anti-HBs: Negative; HBeAg: Negative; Anti-HBe: Positive; PCR-HBV DNA Negative.

What does these mean?