Chronic mild ALT elevation

[simsim26]

Hi,

I'm a 22 year old male, living in the US.

I have been having elevated ALT levels for the past 12 months. It was a random finding in December 2017 during a physical (ALT: 109). I was retested in May 2018 and the level had gone done but were still elevated (69). Finally, I was retested this month and the level was high again (103). Therefore, it prompted a referral to GI and a battery of test. Ultrasound came back completely clear. I had a full autoimmune panel done (AMA, ANA, Anti-Smooth Muscle), all viral Heps (3 times), Hematochrosis, Wilson’s, Alpha-1, Celiac, IgG/IgM levels were controlled, pancreas function, diabetes panel, cholesterol panel, iron panel, CBC, LFT panel (including GGT, ALP, AST, ALT, Albumin, Bilirubin direct and total), thyroid panel - every single thing is normal.

My GI specialist is at loss and recommends a liver biopsy. I got a second opinion from another specialist: still no idea what could be wrong but does not recommend a biopsy. Myself, as a patient, is lost. First of all, while I do understand the difference between ALT and AST, and their location within the cell, I do not understand how I can have a chronic elevation of ALTs without ASTs being elevated as well. Two, given the extensive panel that was given, and my cytolytic profile, without any signs of cholestasis, I do not understand what else can be given.

I do not drink at all, I have not shown any unwanted weight loss, I have a normal BMI. No signs of jaundice, pruritus (which is normal given the normal bilirubin), no abnormal fatigue. I do have a slight discomfort in my RUQ right where the ribs end (no pain under ribs) - it is actually more within the very right end side of the epigastrium.

I came here not to get a diagnosis, as I am fully aware that without access to my full medical chart and without the ability to give me a thorough clinical exam, it is not possible. However, I would like to have some professionals’ insights and people that have had similar results as to what other differential diagnosis we should be looking at, as unfortunately, I feel lost between the conflicting answers from the two specialists I have seen and both of them do not know what is wrong.

PS: One of the possible diagnosis could MAYBE be Hep E. However, I do not have any risk factors for Hep E.

[Hidden]

The users of this site are not medical professionals, but people who have gone through similar condition. They are able to talk of there own experiences from a personal perspective, and not from a medical one.

Hope this helps.

[Hidden]

Hi simsim26,

I don't know where you live, but sometimes one can get a 3rd referral if the 2 you got are opposite. Don't know that it would be good thing, just a possibility.

Best wishes,

Mary

[simsim26]

Thanks for both of your answers - I am getting a third opinion but dont expect much changes from the previous answers. Given that its only my ALTs and a mild elevation, it feels like the doctors are also inclined to dismiss it quickly.

@ynbaouchi: did you also experience some light discomfort in your liver area?

[Lindar1961]

Hello, I hope you find answers.

[Kristian]

Hi Simsim,

Alas you may have joined the inigma club. This does though offer up opportunities to join the diagnostic dilemma society and the medical mystery association further down the line.

Seriously though, unfortunately, sometimes it can be very problematic to reach any form of diagnosis based on one abnormal test. Indeed, it can be equally problematic even with more than one. (I speak from experience there, lol). The only thing to do i'm afraid is to keep monitoring it. It'll be frustrating as hell, especially if all the other tests remain normal. However at least if they do monitor it they should pick up if anything changes that may lead to a diagnosis in the future.