Hello Dear, I understand your concern and it might be very disturbing especially after going through all the lab test and almost everything seems normal except for the liver enzymes (indicating liver failure). The symptoms and the elevated liver enzymes as you describe might signify an autoimmune hepatitis. Autoimmune hepatitis is inflammation of the liver that occurs when immune cells mistake the liver s normal cells for harmful invaders and attack them. It might occur along with other autoimmune diseases. Your doctor might need to request some tests to confirm the suspicion. Tests for autoimmune hepatitis include: - Anti-liver kidney microsome type 1 antibody (anti LKM-1) - Anti-nuclear antibody (ANA) - Anti-smooth muscle antibody (SMA) - Serum IgG - Liver function tests (already done, other enzymes could be tested too) - Liver biopsy to look for chronic hepatitis Treatment :You daughter may need prednisone or other corticosteroid medicines help reduce the inflammation. Azathioprine and 6-mercaptopurine are drugs used to treat other autoimmune disorders. They have been shown to help people with autoimmune hepatitis, as well. Now lets not go too far. If you are in a context where malaria is endemic, then it is possible that malaria might be responsible for the above symptoms. Other parasitic or viral infections that present like malaria such as dengue fever, schistosomiasis etc needs to investigated and if they are responsible should be treated. Hope this could be hepful