Male 31, AST 563, ALT 1,575. Could it be ibuprofin?

[burgieman]

Hello there.  I've seen many postings but not with levels this high and I am concerned.  I'm in Asia for 4 months. 6 weeks ago I had a fever for a couple of days with a tight feeling head.  I've also been taking lots of Ibuprofin for back pain.

A month went by and my heart felt fluttery every once in awhile.  I’ve felt this in the past but seldomly.  One month after the fever I went into the hospital to check my ticker because I had a whole day of the fluttery feeling.  Vital signs were normal.  They placed a heart monitor on for 24 hours which appeared normal.  

They also ran a blood test which showed the following.

Non Panel Items
FPG 81 mg/dl
BUN   15 -
Creatinine 1.3 -

Lipid Profile
Cholesterol 192 -
Triglycerides 101 -

HDL
HDL 51 -
CHOL/HDL 3.8 -
LDL (Calculation)
LDL (Calculation) 121 -
LDL/HDL 2.4 -

LFT Profile
Total Protein 8.2 gm/dl
Albumin 4.2 -
Globulin 4 -
Direct Bilirubin 0.4 mg/dl
Total Bilirubin 1.2 -
Alk Phosphate 79 u/l
SGOT/AST 520 u/l
SGPT/ALT 1,012 u/l
Gamma GT 80 u/l

CBC
WBC 4 x10^3/ul
WBC differential
Neutophil 54 %
Lymphocyte 29 %
Monocyte 14.9 %
Eosinophil 1.8 %
Basophil 0.3 %
Atyp. Lymph 0
Band 0
NRBC 0 /100 WBC
RBC 5.05 x10^6/ul
Hb 15.7 gm/dl
Hct 46.7 vol%
RBC Indicies
MCV 92.4 fl
MCH 31.1 pg
MCHC 33.7 gm/dl
RDW 12.6 %
RBC Morphology
Arisocytosis -
Macrocyte -
Microcyte -
Poikilocytes -
Target cells -
Fragmented cells -
Ovalocyte -
Hyprochromia -
Polychromasia -
Platelet Count 224 x10^3/ul

Anti HIV (Stat) Negative

T3 119 ng/dl
Free T4 1.4 ng/dl
TSH 1.83 uU/ml



From here the doctor ran a secondary test for Hep viruses.  Before Travelling I had both my Hep A and B vaccines and they are both working.

Anti HAV IgG Positive
Anti HAV IgM Negative
HBsAG Negative
HBsAb Positive
HBc IgM Negative
Anti HCV Negative




He then sent me for an ultra sound which showed:

U/S of the upper abdomen:
Normal size and echoes of the liver and spleen
No space taking lesion.
Thin wall GB without stone
Normal CBD and Pancreas and Kidneys

Impression:  Normal study of the upper abdomen



He put me on B1, B6, B12 ( 100,5,50 mg) and supplement.   After 5 days I went in for another blood test to see if the levels had lowered for AST and ALT.   Vital signs were normal.  The results were higher.


LFT Profile
Total Protein 7.4 gm/dl
Albumin 4.8 gm/dl
Globulin 2.6 gm/dl
Direct Bilirubin 0.4 mg/dl
Total Bilirubin 0.8 mg/dl
Alk. Phosphatase 110 u/l
SGOT/ALT 563 u/l
SGPT/ALT 1,575 u/l
Gamma GT 184 u/l

At this point he said to rest and take the suppliment and have another test in a week.  

Is this dangerous to my liver?  What sort of virus could it be?  Will I always have it?  Is it contagious?
How could I have got it?

[Kevin Pho, MD]

These liver enzymes are indeed concerning.  Hepatitis would certainly be of concern - however, you are correct in saying that the results are consistent with immunization against Hep A and Hep B.  Ultrasound noted to be normal as well.  

Next thing to consider would be medications.  Depending on how much Ibuprofen you are taking, this can certainly cause elevated enzymes.  I would consider stopping this.  Also, any Tylenol should be stopped as well.  

If everything remains negative, and the enzymes keep rising, more specialized testing is necessary.  This would including tests for autoimmune hepatitis (i.e. autoantibody levels) as well as a liver biopsy.  

As for viruses - that would depend on what kind is present.  HIV and hepatitis both negative.  You may want to consider being tested for EBV or CMV as well to be complete.

You can discuss these options 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

[yoshi]

which country in Asia did you visit??
did any of your tests cover bacterial infection??
what did you eat,what did you drink,where did you stay??
how often did you wash your hands??

[burgieman]

I drove here from California.  (www.drivearoundtheworld.com) so i've been all through central, south america, australia and SE ASIA.  Currently in Laos.  the tests were done in an amazingly modern hosp in Bangkok. Been eating almost anything. Street vendor food but always bottled water.  Drinking has been a regular past-time on this trip because its so long and we hit it pretty hard for a week when we arrived in BK.  I've also been taking quite a lot of Ibuprofin.  I have two herneated vertebrae discs and they slipped in S america.  So something like 8mg 2 x a day of ibuprofin on and off when the pain is bad.  I was also taking anti malarials for about 2 months until local docs said its better not to because you then know when to treat it.  

[yoshi]

buying food from street vendors in third world countries,i am surprised your doc did not check you for bacterial infection,most common is h pylori.

[jonihs]

The combination of alcohol and Tylenol can cause those levels to be high. I would ask my Dr. about alcoholic hepatitis and ask him/her to do a liver funtion panel + biopsy.

[ratbag]

i would definitely avoid all alcohol and fatty foods for now!
I have a similar back problem to yours - and my doctor prescribed di-hydrocodeine instead of ibuprofen for the severe pain, as it does not affect the liver.
Good luck with diagnosis of your problem.