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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Do normal liver function test results rule out autoimmune Hepatitis?

Answered by
Dr. Suresh Heijebu

General & Family Physician

Practicing since :2010

Answered : 3590 Questions

Posted on Mon, 6 Aug 2018 in Lupus
Question: Good morning! My questions might be most appropriate for a rheumatologist(?), but I'm not sure you have one on staff?


I'm currently being treated for Lyme Disease and co-infections (Mono/HHV-6/Flu). Among my huge battery of tests, the one for Smooth Muscle AB came back positive. My doctor explained that this test is used to check for autoimmune hepatitis, but considering my other normal test results (such as liver enzymes), he ruled that out and said I have no reason to worry. My questions are: 1) If the result doesn't indicate AI Hepatitis, what DOES it indicate? 2) Since smooth muscle is all over the body, does this positive result indicate that the smooth muscle in my stomach, esophagus, lungs, and blood vessels has been compromised or damaged/weakened in some way? That would seem to make sense since Lyme attacks connective tissue. 3) Are any sort of tests that I should be going through to make sure those areas are intact and OK? 4) Could the positive AB result be temporary and resolve with Lyme treatment? 5) Could a positive AB result in any way indicate Ehlers-Danlos Syndrome?
Answered by Dr. Suresh Heijebu 2 hours later
Hello and Welcome to ‘Ask A Doctor’ service. I have reviewed your query and here is my advice.

Brief Answer:
Screening for autoimmune connective tissue disorders is mandatory

I have worked through your attached query in detail

Anti Smooth muscle antibody ( ASMA) should be carefully evaluated in your case. It's important to rule out autoimmune connective tissue disorder by appropriate testing.

Normal liver function tests does not rule out autoimmune Hepatitis.

False positive ASMA can be a feature of viral Infection like Mononucleosis, HHV etc but very unlikely for Lyme's

ASMA positivity does not always confer serious and significant damage to smooth muscles all over your body.

At this point of time, I advise you to get a complete ANA PROFILE ( otherwise called ENA BLOT), a test that can accurately identify the autoimmune connective tissue disorders if any.

ASMA is not related to Lyme's disease treatment and does result in Ehler Danlos syndrome whatsoever.

The status of ASMA positivity can be predicted based on test results of ENA BLOT.

Hope I have answered all your questions. Are you satisfied with my consultation ? Is there anything else left to be discussed ?
Above answer was peer-reviewed by : Dr. Prasad
Follow up: Dr. Suresh Heijebu 1 hour later
Doctor, THANK YOU for your speedy and encouraging reply!

I did, in fact, have blood work done for the entire panel of autoimmune connective tissue disorders. Every one (Scleroderma, Lupus, RA, Sjogren's, etc.) came back negative. The only positive result I got was a positive ANA. But the doctor said it was so slight that it was almost negligible.

That said ... all those tests came back OK, and so did my liver enzymes and a scan of my liver (it showed no enlargement). One ultrasound did show a slightly dilated bile duct, but the next scan a week later (an endoscopy with ultrasound) showed the inflammation had gone down considerably.

So ... I guess my remaining question is: Are the positive ANA and slightly-inflamed bile duct enough to cause the Smooth Muscle AB to be positive? If not, any other ideas as to what could cause the +AB?

That's it. Thank you again for helping me!
Answered by Dr. Suresh Heijebu 6 hours later
Brief Answer:
Positive ASMA develops independently

Detailed Answer:
Hello Madam

I can certainly understand your concern

Positive ANA( mild) and inflamed bile duct on liver don't cause the formation of positive ASMA.

Positive ASMA develops independently in the context of associated viral Infections like Mononucleosis/HHV ( past or active Infection)

As the liver changes subsided there is nothing to worry or be overconcerned.

Make sure to get your viral Infection ( Mononucleosis/ HHV 6 ) be adequately treated.

To conclude just keep a watch on your liver function by having an ultrasound abdomen and liver function tests checked every 6 months.

Hope I have answered your query. Let me know if I can assist you further.
Above answer was peer-reviewed by : Dr. Yogesh D

The User accepted the expert's answer

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