Major elevation in liver enzymes! What happened?

[Grace]

Hi all. I haven’t been on the board in a while. Ironically I thought my daughter would be writing a testimonial soon. BUT…. In early December she was feeling great. One year on mino with the normal ups and downs and it looked like it was working. I need to mention it was still hard going in August so her dr gave her clindimycin 2 days a week with mino the other 5 days. By December things were feeling great. Then a routine lab showed ast of 161 and alt of 417! A week later, saw the doctor and he was Very concerned ( guess he doesn’t look at labs until the patient comes in ). Took more tests that day and ast was 210 and alt 496! What!? So doctor said stop all meds and all supplements. Everything but 7 mg of prednisone a day. It has been 25 days and just got new bloodwork yesterday. Numbers are almost normal, thank goodness, but her doctor said to take no meds or supp. Except 2 krill oil a day and in another 5 days bloodwork again. But after almost a month without meds or supplements she is in such pain. Does anyone have ideas about what might help that we could ask the dr about. It is almost crippling 🙁
Thanks to all for your insight.
Be well 🙂

[Grace]

I’ve been trying to research this and I think Maz mentioned having a problem similar to this. Forgive me, I’ve read so much, I’m getting confused. Is there another antibiotic that can be substituted? Thanks again!

[lynnie_sydney]

Grace
This is the thread you might be looking for – Maz posted about her elevated Liver Enzymes towards the end of it. A useful thread to look through in general. (I found it by typing Liver Enzymes into the Seach Box at top of front page of General Discussion).

viewtopic.php?f=1&t=11558&p=75807&hilit=liver+enzymes#p75807

You can also read about my own liver enzyme crisis in 2009 in my Personal History thread. My ALT numbers were over 700. Good news is that I resumed antibiotics after several months and have not experienced the same issue again and my Smooth Muscle Antibody numbers are now well within normal range (these indicated autoimmune in the liver). It may take some sleuthing because it may be one of the abx she has reacted to…..I’d be asking the doc about slowly re-introducing one at a time once all numbers have stabilised at normal.
De-toxing to get and then keep enzymes in normal range will be key as a first step. The best thing I used for this was a kale and umboshi broth (details on this in my Personal History thread – page 2).

Be well! Lynnie

Palindromic RA 30 yrs (Chronic Lyme?)
Mino 2003-2008 100mg MWF - can no longer tolerate any tetracyclines
rotating abx protocol now. From Sep 2018 MWF - a.m. Augmentin Duo 440mg + 150mg Biaxsig (roxithromycin). p.m. Cefaclor (375mg) + Klacid 125mg + LDN 3mg + Annual Clindy IV's
Diet: no gluten, dairy, sulphites, low salicylates
Supps: 600mg N-AC BID, 1000mg Vit C, P5P 40mg, zinc picolinate 60mg, Lithium orotate 20mg, Magnesium Oil, Bio-identical hormones (DHEA + Prog + Estrog)

[PhilC]

Hi Grace,

Without knowing exactly what she was taking, we can only guess as to why this happened.

Phil

"Unthinking respect for authority is the greatest enemy of truth."
- Albert Einstein

[lynnie_sydney]

Without knowing exactly what she was taking, we can only guess as to why this happened.

Grace, it would help people respond better with their thoughts if you put together some info in a signature which will come up each time you post. I looked back at your earlier posts and can see what your daughter started on and then moved to. It will be helpful for other people if you could summarise this info in a signature. You can see what others have done in this regard. To do this, you just go to User Control Panel (top left), Profile, Edit Signature and then input the information. Will also help you not have to constantly repeat things in posts.

Be well! Lynnie

Palindromic RA 30 yrs (Chronic Lyme?)
Mino 2003-2008 100mg MWF - can no longer tolerate any tetracyclines
rotating abx protocol now. From Sep 2018 MWF - a.m. Augmentin Duo 440mg + 150mg Biaxsig (roxithromycin). p.m. Cefaclor (375mg) + Klacid 125mg + LDN 3mg + Annual Clindy IV's
Diet: no gluten, dairy, sulphites, low salicylates
Supps: 600mg N-AC BID, 1000mg Vit C, P5P 40mg, zinc picolinate 60mg, Lithium orotate 20mg, Magnesium Oil, Bio-identical hormones (DHEA + Prog + Estrog)

[Grace]

Thanks Lynnie.
I just put info in the file. I will look at your personal history now, as well as Mazs to see what questions we should be asking the doctor. Phil, I just filled in the history part. Hope that helps. The sad part is that she never felt better than she did by December! If she hadn’t had a routine lab Dec. 12, we would never have known anything was wrong. August lab was normal. This is a good reminder to get those labs.

[Maz]

@Grace wrote:

Thanks Lynnie.
I just put info in the file. I will look at your personal history now, as well as Mazs to see what questions we should be asking the doctor. Phil, I just filled in the history part. Hope that helps. The sad part is that she never felt better than she did by December! If she hadn’t had a routine lab Dec. 12, we would never have known anything was wrong. August lab was normal. This is a good reminder to get those labs.

Hi Grace,

Sorry to hear about your daughter. Yes, I’ve had elevations in liver enzymes several times in the past – gall bladder probs (resolved with liver flushing and various supps), and also when I first got Lyme as it got into my liver (prior to abx therapy). High dose abx for the Lyme brought my liver enzymes down within a month. Go figure, eh? I’ve also had minor elevations in liver enzymes during the course of abx therapy and have just taken a short break, done a liver flush and everything resolved within a couple weeks. In my case, I think I have a predisposition to gall bladder issues and also the darn tricky Lyme bug complicating things further.

There can be all kinds of reasons for elevations in liver enzymes, in addition to the abx (e.g. something as simple as regular alcohol consumption while on therapy, an infection, liver/gall bladder disease, other meds, etc). There is also condition that can arise in some rarer instances, called “autoimmune hepatitis,” which can be due to infection or certain drugs, of which minocycline can be one, but others that are also commonly used by rheumatics, such as Humira (adalimumab) or Remicade (infliximab), as per the Medscape article excerpt below – worth reading this whole link with all its tabs just to get informed:

http://emedicine.medscape.com/article/172356-overview#aw2aab6b2b3

“Some cases of drug-induced liver disease have an immune-mediated basis. A number of drugs (eg, methyldopa, nitrofurantoin, minocycline,[17] adalimumab,[18] infliximab[19] ) can produce an illness with the clinical features of autoimmune hepatitis. Although most cases improve when the drug is stopped, chronic cases of autoimmune hepatitis may be seen, even after drug withdrawal.[20]”

The only way to know for sure if someone has drug-induced or autoimmune hepatitis from some other cause is to have a full panel of labs performed. As Lyn mentioned, the anti-SM antibody test is important in addition to others. As your daughter is doing so well on her AP for her RA, even if the doc says not to worry as her liver enzymes are decreasing, if she wants to continue with AP, it would be sensible to get this potential ruled in/out for peace of mind. The doc may be reluctant to allow her back on AP, just assuming it’s from the mino, when it might just be due to something else, like a transient elevation due to a bug or gall bladder sludge/stones. Also, if she didn’t experience any typical symptoms of drug-induced hepatitis, then it could well be something very simple that could be rectified. E.g. diet (removing all bad fats and sugars), adding liver-friendly supps, like milk thistle, NAC and lecithin, avoiding alcohol.

http://emedicine.medscape.com/article/172356-workup

Clinicians must consider the diagnosis of autoimmune hepatitis in any patient who has acute hepatitis or acute liver failure (defined by the new onset of coagulopathy). In addition to aminotransferase levels and other liver function studies, the workup of such patients should include the following assays:

[Grace]

Maz,
Thank you for so much info! Now we can see if the tests you mentioned have been done yet. If not, I’ll email the doc and request them! Knowledge is indeed power. Thanks to all the board members and guests. This site is a life saver!
Be well.

Grace

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