Unexplained Hepatitis After Liver Biopsy: Causes and Concerns

Q: Unexplained Hepatitis After Liver Biopsy: Causes and Concerns

Hello： 1. There are still cases of hepatitis of unknown origin in clinical practice. 2. The duration of inflammation depends on whether the underlying cause has been identified and addressed or excluded. 3. It is still possible for levels to fluctuate, as the

Post-biopsy unexplained hepatitis?

Dear Dr.
Tsai,
Hello! My husband, who is 36 years old, discovered an elevated GPT level of over 900 during a blood donation at the beginning of the year, which led us to start relevant examinations.
Previously, his annual health check-ups had all been normal, with the last check-up in October of last year also showing normal GPT levels.
Aside from the elevated GPT, all other liver function tests were normal.
There were no signs of hepatitis A, B, or C viruses, and no autoimmune issues.
An ultrasound revealed mild fatty liver.
He does not take any medications and does not consume alcohol.

Due to the inability to identify the cause and the fluctuating GPT levels, a liver biopsy was performed at the end of February, which also showed no abnormalities.
The report indicated a "suspected" acute hepatitis due to drugs/toxins, and he is currently in the acute inflammatory phase.
Since my husband changed jobs to a battery manufacturing company last October (where he is exposed to heavy metals and organic chemicals), we provided the toxicology specialist with information about the heavy metals he might be exposed to.
The doctor stated that these substances would not cause hepatitis, and many of my husband’s colleagues who have worked there for several years have not experienced any liver issues.
To summarize my husband's GPT trends:
- 1/13: over 900
- 1/15: over 700
- 1/22: over 200
- 1/29: over 300
- 2/5: 480
- 2/19: 766
- 2/25: 560
- 3/6: 422
- 3/13: 402
After decreasing from over 900 for three weeks, the levels rose again for three weeks, and now they have started to decline again, but the rate of decrease is very slow (only a 20-point drop this week compared to last week).
Currently, the doctor has stated that all medically available tests have been conducted, and we can only observe the situation without any medication prescribed.
My husband is scheduled to return for a follow-up in two weeks.
I would like to ask the following questions:
1.
Is it true that there are many cases where even after a liver biopsy, the cause remains undetermined?
2.
How long does it typically take for inflammation to normalize in cases of acute hepatitis?
3.
Is it common for the acute phase to show fluctuations in levels, such as initially decreasing and then increasing again?
4.
What additional steps do you recommend we take? Given that he has been experiencing inflammation for two months without a known cause, and we are unable to treat it and can only wait, we are very concerned about the possibility of it progressing to chronic hepatitis or fibrosis.
I would appreciate hearing different doctors' thoughts and recommendations.
Thank you very much for your attention!

Mrs. Li, 30~39 year old female. Ask Date: 2018/03/13

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: 1.
There are still cases of hepatitis of unknown origin in clinical practice.
2.
The duration of inflammation depends on whether the underlying cause has been identified and addressed or excluded.
3.
It is still possible for levels to fluctuate, as the cause has not yet been determined.
4.
It is recommended to avoid health supplements and, if possible, to minimize exposure to heavy metals and organic chemicals, as sometimes non-toxic substances can still cause adverse allergic reactions due to individual sensitivities.
Changhua Hospital cares about your health.
Dr.
Tsai An-shun.

Reply Date: 2018/03/13

More Info

Dear Patient,
Thank you for reaching out with your concerns regarding your husband's unexplained hepatitis following a liver biopsy. I understand that this situation can be quite distressing, especially given the fluctuating liver enzyme levels and the lack of a definitive diagnosis. Let’s address your questions one by one.

1. Unexplained Hepatitis and Liver Biopsy: It is indeed possible for liver biopsies to return inconclusive results, especially in cases of acute hepatitis where the underlying cause may not be immediately identifiable. There are numerous cases in clinical practice where patients present with elevated liver enzymes, and despite thorough investigations—including imaging, blood tests, and liver biopsies—no clear etiology is found. This phenomenon can occur due to various factors, including transient viral infections that may not be detectable at the time of testing, or even autoimmune processes that are not fully expressed.

2. Duration of Acute Hepatitis: The duration for liver enzyme levels to return to normal can vary significantly depending on the underlying cause of the hepatitis. In cases of acute viral hepatitis, for example, liver enzymes may normalize within a few weeks to months. However, if the cause is related to toxins or drugs, the recovery may take longer, especially if there is ongoing exposure. Continuous monitoring of liver function tests is crucial during this period.

3. Fluctuating Enzyme Levels: It is not uncommon for liver enzymes to fluctuate during the acute phase of hepatitis. This can be attributed to various factors, including the body’s immune response to the liver injury, potential ongoing exposure to hepatotoxic substances, or even the natural course of the disease. The pattern you described, with initial decreases followed by increases, is consistent with the unpredictable nature of liver inflammation.

4. Next Steps and Recommendations: Given the current situation, it is essential to continue monitoring liver function closely. Here are some recommendations:
- Avoid Alcohol and Hepatotoxic Substances: Ensure that your husband avoids alcohol and any medications or supplements that could potentially harm the liver.

- Regular Follow-ups: Schedule regular follow-ups with a hepatologist or a gastroenterologist who specializes in liver diseases. They may suggest additional tests or imaging studies to rule out other potential causes.

- Consider Environmental Factors: Since your husband has been exposed to chemicals in his new job, it may be worthwhile to consult with an occupational health specialist. They can assess whether there are any specific risks associated with his work environment that could contribute to liver inflammation.

- Lifestyle Modifications: Encourage a healthy diet, regular exercise, and adequate hydration. These lifestyle changes can support liver health and overall well-being.

- Seek a Second Opinion: If you feel uncertain about the current management plan, seeking a second opinion from another liver specialist may provide additional insights or alternative approaches to diagnosis and treatment.

In conclusion, while it can be frustrating to deal with unexplained liver inflammation, it is important to remain vigilant and proactive in monitoring and managing your husband’s health. The liver has a remarkable capacity for regeneration, and with appropriate care and lifestyle adjustments, many individuals can recover from acute liver conditions without progressing to chronic disease.

Please feel free to reach out if you have further questions or need additional support.

Best regards,
Doctor Q&A Teams

Similar Q&A

Understanding Liver Biopsy Risks and Emotional Support for Families

Dear Dr. Yang, My child recently attended a class reunion dinner and felt unwell the next day, prompting an immediate visit to the emergency room. Initially, we thought it was just food poisoning, but the doctor informed us that the examination revealed stomach swelling, with a ...

Dr. Yang Peizhen reply Gastroenterology and Hepatology
Hello! There are many causes of gastrointestinal discomfort, and hepatitis is one of them. Your son's blood test results show a liver inflammation index (GPT) of 323. If this data is accurate, it indicates a moderate level of liver inflammation. There are many causes of hepa...

Understanding Unexplained Hepatitis: Treatment Options and Prevention Strategies

Dear Dr. Su, I hope this message finds you well. I sincerely appreciate you taking the time to respond amidst your busy schedule. I would like to express my utmost gratitude. I recently underwent liver function tests, which revealed elevated levels of GOT and GPT. My doctor in...

Dr. Su Baojia reply Gastroenterology and Hepatology
1. Unexplained hepatitis requires follow-up examinations. 2. Some hepatoprotective medications can be administered initially. 3. After two to three months of medication treatment, liver function tests should be performed to assess recovery. It is important to rest and avoid alcoh...

Understanding Hepatitis B: Impacts on Liver Health and Dietary Considerations

Hello Dr. Tsai: If a patient has undergone a liver biopsy due to hepatitis B and is now immune, does this indicate that there has been significant damage to liver function (such as fibrosis or hepatitis)? If so, aside from regular follow-ups every six months, what specific dietar...

Dr. Cai Zonglong reply Internal Medicine
Hello, the immune response after a liver biopsy only indicates that the patient's liver function or liver inflammation was abnormal during that period; it does not necessarily imply severe fibrosis or irreversible damage. For patients with liver disease, we usually recommend...

Understanding Liver Health: Concerns About Elevated Liver Enzymes and Tumors

Hello doctor, I went to the hospital for a blood test to check my liver function because I felt fatigued. I also had an abdominal ultrasound. The doctor said I do not have hepatitis B or C, but my liver enzymes are 299 and 69, which is a bit strange. Additionally, the ultrasound ...

Dr. Chen Shidian reply Gastroenterology and Hepatology
Hello, Guoqiang: Liver biopsy is an important method to directly obtain liver (tumor) cells to confirm the cause of the condition. It has a high safety profile, so there is no need to worry. Please discuss the details with your physician. Changhua Hospital cares about your health...