Hight Liver Enzymes/Doc Wants a Biopsy

[mitchcbr]

Hello, just before Thanksgiving, I came down with a fever that lasted 5 days. On the 5th day, I developed a very bad headache/migraine that lasted 3 days. During the fever I went to the doc, who tested me for strep, which came back negative. She said if I had the flu, I’d be better in a few days. Fast-forward to the 3rd headache day: I went to an urgent care place that drew my blood. They discovered high liver enzymes: AST=500’s, ALT=600’s, ALP=188, liver function normal. They sent me to the ER to get an ultrasound, which came back normal. Two days later, they draw my blood again: AST=310,ALT=780,ALP=same. The doc refers me to a GI specialist. One week later, they test me again: AST=34, ALT=220, ALP=117. Three weeks later (a couple days ago): AST=95, ALT=183, ALP=67. I never exceeded 2g (worst case estimate) of Tylenol in 24hrs during my fever. They’ve tested me for tons of diseases, all negative: Hep A-E, CMV, Monospot. EBV IgM was negative, but EBV IgG was positive. They docs seem to think I had mono, but they don’t seem convinced, and the IgM test was negative. I’m not a heavy drinker; I rarely exceed 10 drinks a week. I don’t do drugs. I have one prescription I take very rarely for eczema. I don’t know what to do. I feel like the docs are confused, and now they want a liver biopsy. Frankly I am now terrified. Should I do it? Seek a 2nd opinion? I’ve read that exercise can elevate the transaminases; I worked out pretty hard shortly before developing the fever, and was extremely sore; I also ran four miles the days just before my most recent test.

[mikesimon]

Thank you for sharing your great news.
Congratulations!

Stay well,
Mike

[mitchcbr]

I thought give an update. The post by mikesimon was spot on: I did not trust the first doctor at all; I felt like I was being used as a learning experience for new doctors. I actually ended up going to a different doctor for a 2nd opinion. The doc had a wait list, and it took a month to get in. By then, my enzymes had gone down to normal on their own. They took my blood again another month later, and they were still normal. It took about 2.5 months for them to go down on their own. I never did find out what I had. They tested me for Hepatitis A-E, EBV (traditional mono), Cytomegalovirus, and a few variations of auto-immune hepatitis: all negative. The doc just concluded that I had some unknown virus and that my liver was a bystander in the battle. He said I may have fatty liver disease (even though my ultrasound was unremarkable), and he suggested I lose weight. I'm 5'6", and I was weighing 205lbs; down to 186 right now. I never did really notice any symptoms of liver issues, but I sure wish I new what bug I had.

[mikesimon]

I think it really comes down to how much confidence you have in your doctor.
From what you've said it appears as if your liver enzymes are coming down and my hunch is that they will normalize in a couple of weeks if the trend continues. I have had a lot of liver biopsies and my experience has been that they are not a big deal. Of course, a lot depends on the physician performing the biopsy as well as the procedure that is being used. If I had the choice I would insist on an image guided procedure - for example an ultrasound guided liver biopsy. It's just more precise and seems to go easier. But I have had all types of biopsies and I never had any problem whatsoever. Having said that unless I really had confidence in my physician I don't know that I would immediately queue up for a liver biopsy on the basis of what you've said here. If you are feeling better and have no significant symptoms I might want to wait a couple of weeks and re-test. I think it is quite possible that you had a mono infection and that was the cause of your elevated liver enzymes. But, if you have a lot of confidence in your doctor I would follow his/her recommendations and if he said biopsy I would do it. Otherwise I might ask your doctor if you could wait a couple of weeks and re-test. Either way I wouldn't get too worked up about it. I think most people tolerate the procedure quite well. There are risks with liver biopsies but the vast majority of them are go very smoothly.

Good luck,
Mike

And yes, strenuous exercise can elevate liver enzymes.