An Unexpected Cause of Fever and Elevated Liver Enzymes

Excerpt

A 66-year-old male patient was referred from an outside facility for investigation of fever and abnormal liver tests. At the outside facility, he had been hospitalized for 5 days following the development of fever, chills, rigors, and intermittent confusion over the 3 weeks prior to presentation and had lost 30 lb over a 6-month period. He had no history of abdominal pain, jaundice, sick contacts, or recent travel. Laboratory tests showed serum concentrations of aspartate aminotransferase (AST) 153 IU/L (10–42 IU/L), alanine aminotransferase (ALT) 225 IU/L (10–40 IU/L), and alkaline phosphatase of 1108 IU/L (32–140 IU/L). One week prior to the evaluation at the referring facility, he had been admitted to another hospital suffering from fever and confusion: During admission there, laboratory test results had shown serum concentrations of total protein 5.7 gm/dL (5.7–8.2 gm/dL), albumin 2.6 gm/dL (3.2–4.8 gm/dL), AST 185 IU/L (15–45 IU/L), ALT 236 IU/L (17–63 IU/L), alkaline phosphatase 1294 IU/L (45–129 IU/L), total bilirubin 1.2 mg/dL (0.3–1.2 mg/dL), direct bilirubin 0.6 mg/dL (0.0–0.2 mg/dL), and λ-glutamyl transpeptidase (GGT) 757 IU/L (0–72.9 IU/L). Results of an abdominal ultrasound scan at that time were normal. Diagnosed as “fever of unknown origin,” a brief treatment with prednisone and ciprofloxacin was pursued, but a short time later he was transferred to our facility for further investigation and the treatment was discontinued. …