Possible Fluctuating Enzymes

[FollowUp]

I am an otherwise healthy 36 year old, lots of aerobic exercise and feeling just fine.  I don't have all of my lab numbers in front of me but let me tell you the jist of what's been happening...  About one year ago, bloodwork during a physical showed elevated AST and ALT (in the 60's and 80's with normal being up to 40).  Gastro thought it might be a fluke.  We retested just a couple weeks later they came back COMPLETELY normal (in the 20's and 30's)  So, that was that.  A few weeks ago, I was suffering from an illness (a couple of my friends/coworkers seemed to have the exact same symptoms, headache, fatigue, etc) and everyone who had it felt bad for about two weeks).  Dr. took blood and again ,my enzymes came back high (this time they are in the 200's)Less than a year ago they are completely normal and now they are more than 4x elevated.  They rechecked again about a week after I was feeling much better, and again they came back elevated in the 200's. This time they checked the 'anti-smooth' somethings and those came back within mornal range but my ANA came back 1:135 (apparently just a little on the high side) Negative for all Hep viruses.  Iron levels look fine.  Mono was negative. Gastro says my labs indicate this is not alcohol related.  We did a complete abdominal ultrasound and everything looked normal there.  My cholesterol is only 112.

We are now going to wait about 4 weeks to do blood work again.  If the enzymes are still elevated then we are doing a liver biopsy.  My question is, how likely is it that the possible virus that I suffered from raised my enzymes to 4x normal?  And what would be the next likely illness they might be looking for?  

Thank you for your attention,
Lori

[Kevin Pho, MD]

Yes, it is possible for a virus to transiently raise your enzymes into the 200's.  All the appropriate testing has been done, including ultrasound, ANA level, anti-smooth antibodies, and hepatitis.  Certainly abstain from alcohol if you are drinking.

The next step is indeed a liver biopsy if the enzymes remain elevated 4x normal.  This would be the most comprehensive test to ensure there is no serious disease present.  Although the blood tests looking for autoimmune causes, hemochromatosis, and hepatitis were all negative, it likely is not as accurate as a biopsy.  

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