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• W2913019112 abstract "Abnormal liver enzymes are frequently observed in patients with inflammatory bowel disease (IBD) due to a variety of etiologies, including drug-induced liver injury (DILI) and primary sclerosing cholangitis (PSC), as well as concomitant non-IBD related causes. We report a 43 year-old male patient with pan-ulcerative colitis of 9 years duration treated with infliximab, started 2 years ago, and mesalamine, found to have elevated liver enzymes on routine outpatient bloodwork. His history also includes mechanical valve replacement for mitral valve prolapse, ventricular tachycardia with AICD, atrial fibrillation on warfarin, and coronary artery disease s/p CABG. Laboratory evaluation revealed a mixed liver enzyme pattern with a predominant transaminase elevation (AST>ALT) with a component of significant alkaline phosphatase elevation and transient hyperbilirubinemia. The work-up included a negative acute viral hepatitis panel, negative autoimmune serology panel, negative anti-mitochondrial antibody, and negative hemachromatosis gene mutation testing. Abdominal ultrasound revealed an enlarged, echogenic liver without biliary ductal dilatation. A transjugular liver biopsy showed a high right atrial pressure, high hepatic vein wedge pressure (22 mmHg) and normal hepatic venous gradient (6 mmHg). Histology showed marked steatosis (80%) with early steatohepatitis. ERCP demonstrated poor contrast filling of the intrahepatic biliary tree suggestive of PSC. Due to concern for a contribution of DILI, infliximab was stopped. The patient was also advised to abstain from alcohol. The LFTs slowly declined, and at two-month follow-up, the transaminases and bilirubin were normal, with a mild alkaline phosphatase elevation. Multiple overlapping etiologies for elevated liver enzymes were identified in this patient, including early steatohepatitis (the patient had risk factors of obesity, hyperlipidemia, and cardiac disease), PSC (possibly not seen on biopsy due to sampling as disease can be patchy), DILI related to infliximab (1-51% incidence of elevated transaminases with a 0.2% risk of hepatitis), and alcohol-induced liver injury (AST:ALT greater than 2:1). Elevated right heart pressures were observed, however, given an absence of sinusoidal congestion on biopsy, congestive hepatopathy was thought to be less likely. This case demonstrates the potential diagnostic and therapeutic complexity of liver enzyme abnormality in a patient with IBD and multiple co-morbid conditions.Figure: Liver function test values of AST, ALT and alkaline phosphatase (ALP) over various dates.Figure: The trends of ALP, AST and ALT over time.Figure: The trend of total bilirubin over time." @default.
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• W2913019112 date "2017-10-01" @default.
• W2913019112 modified "2023-09-27" @default.
• W2913019112 title "A Case of Multiple Concomitant Etiologies for Elevated Liver Enzymes in a Patient With Ulcerative Colitis" @default.
• W2913019112 doi "https://doi.org/10.14309/00000434-201710001-02027" @default.
• W2913019112 hasPublicationYear "2017" @default.
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