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Suggest Treatment For Elevated Liver Enzyme Levels

Posted on Mon, 17 Jul 2017

Question: Dear Doctor
I am 50 years old. During my annual checkup in July 2016, I found that my liver enzymes have been elevated to 153 & 198 for SGOT and SGPT respectively while, always my enzymes were normal in whole my life including my last check up of February 2015.
Within two months, enzymes have been elevated to SGOT= 403 and SGPT=586 when I had a liver biopsy together with some more lab tests (attach 1-6). Even though the results of ultrasound and fibro scan were ok and showed no abnormality, autoimmune hepatitis was diagnosed by my doctor who was a Gastroenterologist.
I went on 50 mg Prednisolone as well as 50 mg Azatuprine per day for three weeks which resulted in normal enzymes of SGOT 19 and SGPT 23.
Then my doctor reduced Prednisolone for 5 mg per week (i.e. taking Prednisolone was over and finished after 10 weeks) while still I was on Azatuprine in the February 2016 when the enzymes increased a little (SGOT 40, SGPT 60).
My doctor asked me to continue Azatuprine but as I felt nausea after having said medicine, my doctor substituted Merkaptopurin for it and now, I am on Merkaptopurin since four months ago (75 mg/day) and enzymes are the same as four months ago with no change (SGOT 40, SGPT 60).For your information, both my IGG and GGT are in normal range as attachment 7 (IGG=1379, GGT=13) and I am perfect and have no problem now.
Important and my main issue:
According to above (according to gastroenterologist) the diagnosis is autoimmune hepatitis while immunologist doctor, extremely believes that there is no autoimmune hepatitis and insist on stopping medicine!!!!!
Let me explain their both reasonings:
Gastroenterologist: despite all factors are normal (including negative ASMA and negative ANA –attach 2), the diagnosis is autoimmune hepatitis because FANA is positive and there is no evidence on viral hepatitis.
Immunologist: according to the test results of attachment 8, diagnosis could not be autoimmune hepatitis (for your information, these tests were done 5 days after starting Prednisolone).
Would it be possible to let me know which diagnosis is right?
Best Regards

Answered by Dr. Hardik Sanghvi (2 hours later)

Brief Answer:
It is more likely to be autoimmune hepatitis.

Detailed Answer:
Hi, dear
I have gone through your question.
I can understand your concern.

Your liver enzymes level are high. Your viral hepatitis markers are negative. Biopsy report suggest autoimmune hepatitis. Your globulin levels are high.These all findings suggest possibility of autoimmune hepatitis.

ASMA, LKM antibodies, ANA all are negative. Their positivity is seen in 20 to 30% cases only. In rest of the cases all these definitive markers are negative.

So most reliable tool is histopathology.

However still it is very difficult to diagnose exactly. But in my opinion it's more likely to be autoimmune hepatitis.

Still please send me your all other reports. Like biopsy report, immunoglobulin levels, ultrasound , ANA and all reports you gave gone through. So that I can help you further.

Thanks for using health care magic. Wish you a very good health.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Hardik Sanghvi (13 hours later)

Dear Dr. XXXXXXX Sanghvi

Would it be possible to let me know how can I send you all 8 attachments?

Rgds

XXXX

Answered by Dr. Hardik Sanghvi (4 hours later)

Brief Answer:
You can upload your all reports.

Detailed Answer:
Hi, dear
I can understand your concern.

You can upload your all reports. Just like you have upload two reports. If you have any problems in uploading then you can contact our customer care department for help.

Thanks for using health care magic.
Wish you very good health.

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Hardik Sanghvi (3 days later)

Dear Dr. XXXXXXX Sanghvi

I uploaded missed reports.

Best Regards

XXXX

Answered by Dr. Hardik Sanghvi (18 hours later)

Brief Answer:
Most probably it is autoimmune hepatitis.

Detailed Answer:
Hi, dear
I have gone through your question and your all reports.
I can understand your concern.

Your all markers for autoimmune hepatitis are negative. But histopathology reports suggest chronic hepatitis. Your all viral markers are negative. Your ANA is positive. Your liver enzymes are reduced after giving steroids.

So probably it is autoimmune hepatitis. Many a times all markers are negative and biopsy is the only finding. So in my opinion you may have autoimmune hepatitis. If you want to stop your medicine then consult your gastroenterologist and plan accordingly.

Hope I have answered your question. If you have any doubts then feel free to ask me. I will be happy to answer. Thanks for using health care magic. Wish you a very good health.

Note: Do you have more questions on diagnosis or treatment of blood disorders? Ask An Expert/ Specialist Now

Above answer was peer-reviewed by : Dr. Kampana