Unknown Illness with High SGOT/SGPT and Enlarged Spleen

[Tusc13]

I am a 30 year old male, BMI of about 37, but otherwise healthy. My question has multiple parts, and I appreciate any help. On July 23, I began running a fever (101.8), for which I took tylenol. I was seen by a doctor, who treated me for food poisoning. The next day, my fever was 103, and I was again seen and treated (by antibiotic) for a sinus infection. At this point, I began taking a full dose of extra strength tylenol every 3 hours (not a good idea, I know). That Saturday, my fever was up to 105, accompanied by frequent vomiting, dizziness, vertigo, and an inability to sleep or keep food/fluids down. I was admitted to the ER. A CAT Scan was taken and showed my spleen to be 18 cm. All bloodwork and CAT Scans looked normal, and no other issues were found. I was sent home with instructions to take Tylenol for fever and check with my primary care doctor Monday. My PCP checked me for Hepatitis, Pancreatitis, Mono, and a number of other items through bloodwork. I was still running a fever in the 102-103 range and was vomiting. I was treated for my individual symptoms and sent home. My bloodwork came back fine, with the exception of my liver enzymes (high), white blood cell count (and my doctor decided to treat it as non-typable hepatitis. I began having pain in my upper-left ribcage and mentioned this to my PCP.

My bloodwork returned with low white blood cell count (clustered), low platelet count, and high SGOT (about 250) and SGPT (about 260). By Friday (8 days since this had started), my fever was gone and I stopped taking tylenol. In the two weeks since, my white blood cell count and platelets have returned to normal, and my SGOT is ~80 and my SGPT is ~191, but both numbers have gone down each time they have been tested.

I am still having upper-left abdominal pain, and I am worried my spleen is to blame. My PCP wants to wait a few more weeks before having another CAT Scan done, but I am uneasy regarding my spleen's size. I have two questions:

1) Is a spleen of 18 cm a cause for immediate concern, and could this be a temporary enlargement caused by whatever caused me to be so sick?

2) Could the pain I am feeling in my upper-left abdomen be indicative of a serious problem with me spleen? it is not persistent, but feels sharp, and is often accompanied by belching. It does not seem to be brought on by any activity, and occasionally radiates to my lower gut or around my ribcage and to my back. I am not sure if this could be a GI issue or a possible musical-skeletal rib issue.

Thank you for any help.

[fntn]

If your spleen will recover and drop down to normal size, it should do so relatively quickly, maybe a month or so. My is due to chronically high portal blood pressure, so it's cause for enlargement remains. And if the spleen stays enlarged for a long time, it tends not to recover. I don't think that's what you're looking at though.

[Tusc13]

Thank you for your response. I had actually taken half of a z pack by the time I was admitted to the hospital, so I have no good benchmark for liver functions prior to beginning an antibiotic. I was prescribed the z pack (6 pills total) on Friday, took 2 pills Friday and one Saturday morning (per instructions), and then was admitted to the hospital. I had blood drawn and then was given an IV antibiotic, told to stop the z pack, and prescribed cefdinir.

I have asked for a referral, but my PCP wants to have the results of one more round of bloodwork before he submits his referral. This will be done Monday, so I am hoping to get in to see someone as early as next week.

Right now, the pain in my upper-left abdomen is so bad that I am walking hunched-over and applying pressure. From what you are describing, this could very well be something else. I am just hoping that the follow-up CAT Scan shows a reduction in spleen size. If it is just enlarged from an infection, do you have any idea how long it would normally take before it returns to normal?

[fntn]

You have a confusing story for sure. Did your doctor get a liver function test completed before he started you on the antibiotics? This, along with the combination of Tylenol, will have very likely increased your liver enzyme levels in addition to what the infection was doing. So it would be hard to know exactly what your infection was doing to your liver.

Certainly the follow-up blood work is a good idea. There are a number of unclassified possibilities that you may have come in contact with. But you'd need to see a liver specialist to determine this. You might want to get a referral to a hepatologist.

And hopefully your spleen will recover and reduce in size back to normal. This usually happens in many short term infections like mononucleosis, etc.. If it doesn't though, it shouldn't present a problem health wise. You'll just need to be careful since it is no longer fully protected by your ribs. Mine is enlarged as well, so it's good that I had to stop playing hockey anyway.

Since my spleen is very large, I do feel a dull ache on occasion, but I wouldn't call it pain. So what you seem to describe is likely due to some GI issue. Also, my ache is very focal, but you seem to feel pain over a broader region.