High value of SGPT/SGOT

Respected Sir
Mu son of 5 Years old had raised sgpt/sgot values (500/400))from last one year. he has tested for other LFTs, HAV,HBV, HCV, HCV RNA, ANA, LKM, HEV etc and are normal. Liver biopsy suggestive mild inflamation (inflammation) composed with mainly lymphocytes and negative for fibrosis, cirosis, wilsion etc. health of the child is normal, weight gaining, normal diet pattern and no pain complaint. The doctors do not able to find the alon raised ALT/AST values
I want to know why it may be so and what may be effect on the organ/body of such high values of enzymes. can i send the detail history of the patient for your study>

Thanks

[Thomas D Schiano, MD]

if the alt and ast remain elevated to this level we must suspect giant cell or autoimmune hepatitis.  if they are now normal, alpha 1 antitrypsin deficiency is a possibility.

[vsevach]

Respected Sir

I have already done LKM1, ANA serum and AMA by IF tests for auto imune desease and all these test are negative so autoimune hepatitus (hepatitis) should be ruled out. so what should be next?

[Thomas D Schiano, MD]

hcv- and hbv pcr should be checked as well as HEV.  wilson disease can also cause a hepatitis.

[vsevach]

Respected Sir
I have done HCV, HCV RNA and HBV pcr test are negative. For willson desease ceroplasmin and KF ring ring test had carried out and negative. so willson desease had ruled out by doctors.

[Thomas D Schiano, MD]

i am not sure then.  sometimes an empiric course of steroids is i ndicated in case it would be a type of rejection

[vsevach]

Respected sir
this time I have done blood tests for serum cortisol, alpha-fetoprotien, RBC glycogen content, pt, pttk and ck/cpk. except ck/ckp all other test are normal. value of ck/cpk is 18890 which is very high. I want to know: (1) Is there any relation between sgpt/sgot and cpk (2) is ck/cpk related to liver (3) what further tests should be conducted.
normally child has no complaint of pain but some times when he played for longer time he has complaint of leg pain.

[Thomas D Schiano, MD]

ast can also be a muscle enzyme besides for the liver.  the cpk elevation is unrelated to the liver but may be due to a primary myositis.  this is a very abnormal level.