Fever elevated liver enzymes: Difference between revisions

Revision as of 20:02, 11 September 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2], Usama Talib, BSc, MD [3], Mahshid Mir, M.D. [4]

Conditions that can cause fever and elevated liver enzymes are presented in the table below, ordered based on their prevalence: ^[1]^[2]^[3]

Disease		Clinical manifestations					Laboratory findings			Additional findings
		Symptoms			Signs		Transaminitis (elevated AST and ALT)	Viral markers	Autoimmune markers
		Nausea & vomiting	Abdominal pain	Arthralgia	Jaundice	Hepatomegaly	Transaminitis (elevated AST and ALT)	Viral markers	Autoimmune markers
Acute viral hepatitis	Hepatitis A	+++	++	+	+++	+	+++	HAV Ab	---	Fecal-oral transmission Usually acute and self limit Fever usually present
	Hepatitis B	+++	++	++	+++	+	+++	HBs Ag, HBc Ab, HBe Ag	---	Percutaneous transmission most common May cause acute hepatic failure or may become chronic Fever usually present
	Hepatitis C	+++	++	++	+++	+	+++	HCV Ab	---	Percutaneous transmission is most common Higher rate of chronic progression Associated with extra hepatic manifestation such as cryoglobulinemia and membranoproliferative glomerulonephritis Fever usually present
	Hepatitis E	++	++	+/-	++	+	+++	HEV Ab	---	Fecal-oral transmission May cause fulminant disease in pregnancy Fever usually present
	CMV hepatitis	+/-	++	-	+	+	++	CMV-specific immunoglobulin (Ig)M antibody	--	Usually manifests as mononucleosis syndrome fever usually present
	EBV hepatitis	+/-	++	-	+/-	+	++	Heterophile antibody test, monospot test	--	Systemic manifestations as mononucleosis syndrome Fever usually present
Autoimmune hepatitis		-	+	+/-	++	+	+++	---	ANA, ASMA, anti SLA/LP, ANCA, ALKM-1 antibodies	Liver biopsy may be required for diagnosis
Alcoholic hepatitis		+/-	+	-	+	-	AST>ALT	---	---	History of alcohol intake
Drug induced hepatitis		+/-	+	-	+	+	++	---	---	May cause either cholestatic or hepatocellular injury

↑ Gilson R, Brook MG (2006). "Hepatitis A, B, and C". Sex Transm Infect. 82 Suppl 4: iv35–9. doi:10.1136/sti.2006.023218. PMC 2563900. PMID 17151052.
↑ Heintges T, Niederau C (1993). "Differentiation between autoimmune hepatitis and hepatitis C virus related liver disease". Z Gastroenterol. 31 (5): 285–8. PMID 7686702.
↑ Park JW, Kwak KM, Kim SE, Jang MK, Kim DJ, Lee MS, Kim HS, Park CK (2015). "Differentiation of acute and chronic hepatitis B in IgM anti-HBc positive patients". World J. Gastroenterol. 21 (13): 3953–9. doi:10.3748/wjg.v21.i13.3953. PMC 4385543. PMID 25852281.

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 __NOTOC__
-{{CMG}} ; {{AE}} {{MIR}}
+{{CMG}} ; {{AE}} {{SMP}}, {{USAMA}}, {{MIR}}
+== Differential diagnosis of Fever and elevated liver enzymes==
 Conditions that can cause fever and elevated liver enzymes are presented in the table below, ordered based on their prevalence:
 <ref name="pmid17151052">{{cite journal |vauthors=Gilson R, Brook MG |title=Hepatitis A, B, and C |journal=Sex Transm Infect |volume=82 Suppl 4 |issue= |pages=iv35–9 |year=2006 |pmid=17151052 |pmc=2563900 |doi=10.1136/sti.2006.023218 |url=}}</ref><ref name="pmid7686702">{{cite journal |vauthors=Heintges T, Niederau C |title=Differentiation between autoimmune hepatitis and hepatitis C virus related liver disease |journal=Z Gastroenterol |volume=31 |issue=5 |pages=285–8 |year=1993 |pmid=7686702 |doi= |url=}}</ref><ref name="pmid25852281">{{cite journal |vauthors=Park JW, Kwak KM, Kim SE, Jang MK, Kim DJ, Lee MS, Kim HS, Park CK |title=Differentiation of acute and chronic hepatitis B in IgM anti-HBc positive patients |journal=World J. Gastroenterol. |volume=21 |issue=13 |pages=3953–9 |year=2015 |pmid=25852281 |pmc=4385543 |doi=10.3748/wjg.v21.i13.3953 |url=}}</ref>