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.