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Suffering From Recurrent Episodes Of Fever. Test Showed High SGPT And SGOT Levels. What Treatment Should Be Done?
Question: I am 30 yr old Male, height 5.8, weight 73 kgs.
Since last few of months I have been suffering from recurrent episodes of fever but there has not been a confirmed diagnosis so far. There were 4 such episodes in Jul and August, 2012.
I had the following episodes:
1. First fever – sometime in July’12 – treated as normal viral with Levoflox. Fever lasted 2-3 days. Slight cough present.\
2. Second fever – approx. 1 week later in July’12 – diagnosed as suspected sinusitis – and treated with respective medicines. Slight cough also present.
3. Third fever – 12th August ’12 – fever with shivering – suspected malaria – treated with normal antibiotic, and malaria medicine course for 3 days. Blood report showed very low neutrophils, but they recovered in a week. This fever lasted only two days.
4. Fourth fever – 25th August’12 – fever with weakness. Admitted to hospital for investigations. Suspected enteric fever. Treated with Metrogyl and Monocef with IV for 7 days. CRP was 75 when admitted. Reduced after antibiotics. Fever again lasted for only 2 days.
Current condition:
It’s been 3.5 weeks and I feel fine, and also the fever has not come back. But, since earlier episodes have not been diagnosed, i have gone ahead with following investigations on advice on my doctor.
- My SGOT and SGPT levels have been increasing consistently. Currently it is at 70 and 140 respectively, and this has almost doubled in the last 4 weeks.
Is this a matter of concern?
- I have been diagnosed with non alcoholic fatty liver, as seen in CT scan and ultrasound.
- My Ceruloplasmin test has come at 17.9, lower than it should be, although my 24 hr copper urine test is normal. My blood serum copper has come to 90. A little calculation shows that I do have free copper of around 36.
- My Hepatitis B, surface anti-bodies has come to 39 (< 10), and I don’t think I have ever taken Hepatitis B vaccination. Is this fine?
- Bilirubin has recently also gone up to 0.3
- I have itching on my feet, legs, hands and head.
Someone told that increased copper levels might indicate wilson's disease. How can i rule out presence of this disease?
Based on this, can you please recommend the right course of action going forward?
Since last few of months I have been suffering from recurrent episodes of fever but there has not been a confirmed diagnosis so far. There were 4 such episodes in Jul and August, 2012.
I had the following episodes:
1. First fever – sometime in July’12 – treated as normal viral with Levoflox. Fever lasted 2-3 days. Slight cough present.\
2. Second fever – approx. 1 week later in July’12 – diagnosed as suspected sinusitis – and treated with respective medicines. Slight cough also present.
3. Third fever – 12th August ’12 – fever with shivering – suspected malaria – treated with normal antibiotic, and malaria medicine course for 3 days. Blood report showed very low neutrophils, but they recovered in a week. This fever lasted only two days.
4. Fourth fever – 25th August’12 – fever with weakness. Admitted to hospital for investigations. Suspected enteric fever. Treated with Metrogyl and Monocef with IV for 7 days. CRP was 75 when admitted. Reduced after antibiotics. Fever again lasted for only 2 days.
Current condition:
It’s been 3.5 weeks and I feel fine, and also the fever has not come back. But, since earlier episodes have not been diagnosed, i have gone ahead with following investigations on advice on my doctor.
- My SGOT and SGPT levels have been increasing consistently. Currently it is at 70 and 140 respectively, and this has almost doubled in the last 4 weeks.
Is this a matter of concern?
- I have been diagnosed with non alcoholic fatty liver, as seen in CT scan and ultrasound.
- My Ceruloplasmin test has come at 17.9, lower than it should be, although my 24 hr copper urine test is normal. My blood serum copper has come to 90. A little calculation shows that I do have free copper of around 36.
- My Hepatitis B, surface anti-bodies has come to 39 (< 10), and I don’t think I have ever taken Hepatitis B vaccination. Is this fine?
- Bilirubin has recently also gone up to 0.3
- I have itching on my feet, legs, hands and head.
Someone told that increased copper levels might indicate wilson's disease. How can i rule out presence of this disease?
Based on this, can you please recommend the right course of action going forward?
Hello Mr XXXXXXX and thanks for your query.
I shall make an effort to provide you with good professional recommendations specific to your questions.
I appreciate the time taken for giving out a detailed history.
I can understand you have been through a lot of medical reasons till date.
I want to highlight suggestions for point wise for a possible direction in your future medical management :
1. Chronic Bronchitis and Chronic Ileocecitis - Current status needs review. Likely to cause long standing fever. Exacerbations in between also responsible. What drugs have you used for this apart from antibiotics ? Acute sinusitis would have subsided with them, but certain other drugs like bronchodilators, anti-inflammatory are prescribed for particular conditions.
2. Non-alcoholic fatty liver - Nothing to get scared of here. But, your current Jaundice condition causing you symptoms needs therapy. Again what drugs were prescribed in here ? Jaundice can cause long standing fever too. SGOT and SGPT levels fluctuate with the underlying liver cell damage and repair. They also aid in prognosis. Your values are predictable for this condition - but intervention is awaited to bring it down again.
3. Hyperlipidemia - Considering your higher LDL and other lipid levels, what is the specific history of this. And what has been done to correct these levels.
4. Wilson's disease - Blood tests for copper are not final in diagnosis although point in doubt. Liver biopsy is needed, at times molecular findings too. A genetic test also may be done in some cases. Yes, fever can also be caused due to this entity as well.
Your levels of HepB Ab levels indicate ongoing liver damage, which the body is trying fight against. So, again is predictable. It will decrease with time and healing of liver damage.
Considering your young age, I would want to know after such extensive testing - apart from symptomatic antibiotics as and when your episodes of fever arose, nothing has been written about your treatment history of chronic bronchitis, non-alcoholic fatty liver, hyperlipidemia, wilson's disease.
There are several drugs that are indicated in such conditions, and I am sure you would have to be clinically evaluated for management apart from searching for other causes (I think your exhaustive list of tests is more than enough) for now.
Let me know if I have missed out any other concern in your question.
Yet again, I duly appreciate your query to me, I do hope that you have found something useful to help you and I shall be glad to answer any further apprehensions.
Sincerely,
Dr Sujeet N Charugulla,
MBBS, MD.
Consultant Physician.
I shall make an effort to provide you with good professional recommendations specific to your questions.
I appreciate the time taken for giving out a detailed history.
I can understand you have been through a lot of medical reasons till date.
I want to highlight suggestions for point wise for a possible direction in your future medical management :
1. Chronic Bronchitis and Chronic Ileocecitis - Current status needs review. Likely to cause long standing fever. Exacerbations in between also responsible. What drugs have you used for this apart from antibiotics ? Acute sinusitis would have subsided with them, but certain other drugs like bronchodilators, anti-inflammatory are prescribed for particular conditions.
2. Non-alcoholic fatty liver - Nothing to get scared of here. But, your current Jaundice condition causing you symptoms needs therapy. Again what drugs were prescribed in here ? Jaundice can cause long standing fever too. SGOT and SGPT levels fluctuate with the underlying liver cell damage and repair. They also aid in prognosis. Your values are predictable for this condition - but intervention is awaited to bring it down again.
3. Hyperlipidemia - Considering your higher LDL and other lipid levels, what is the specific history of this. And what has been done to correct these levels.
4. Wilson's disease - Blood tests for copper are not final in diagnosis although point in doubt. Liver biopsy is needed, at times molecular findings too. A genetic test also may be done in some cases. Yes, fever can also be caused due to this entity as well.
Your levels of HepB Ab levels indicate ongoing liver damage, which the body is trying fight against. So, again is predictable. It will decrease with time and healing of liver damage.
Considering your young age, I would want to know after such extensive testing - apart from symptomatic antibiotics as and when your episodes of fever arose, nothing has been written about your treatment history of chronic bronchitis, non-alcoholic fatty liver, hyperlipidemia, wilson's disease.
There are several drugs that are indicated in such conditions, and I am sure you would have to be clinically evaluated for management apart from searching for other causes (I think your exhaustive list of tests is more than enough) for now.
Let me know if I have missed out any other concern in your question.
Yet again, I duly appreciate your query to me, I do hope that you have found something useful to help you and I shall be glad to answer any further apprehensions.
Sincerely,
Dr Sujeet N Charugulla,
MBBS, MD.
Consultant Physician.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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