PSC, AIH, and/or Fatty Liver...thoughts?

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Fletch10
Regular Member


Date Joined Feb 2017
Total Posts : 202
   Posted 12/10/2017 3:53 PM (GMT -6)   
I'm normally on the ulcerative colitis forum but hoping to get some clarity here about liver issues.

My liver function tests were completely normal until April 3 of this year, when my ALT showed 10 points above normal (AST was still normal). At this time I was finishing a 2.5 month course of prednisone and had tried a couple of other UC meds that didn't work. We did this liver test the day I started Remicade, before the medication was administered.

They do LFTs with every Remicade infusion. With one exception, when the tests completely normalized in mid-May, the LFTs have gone up slightly every month.

In September, they did an autoimmune workup and found:

ANA positive at 1:80 with anti-actin antibodies
ASMA positive at 1:80
SPEP, immunoglobulins, iron, AMAs, cerruloplasmin, alpha-1 antitrypsin, celiac panel all normal/negative

My AST and ALT were 51 and 60 last week, which is another slight increase; all other numbers normal though alkaline phosphatase is 106 - that has been increasing slightly, too (though still normal).

I had a liver biopsy on Friday. No results yet but I am freaking out waiting to hear something. I lost my Dad to liver failure when his Hep C recurred in his transplanted liver 13 years ago, so anything liver-related terrifies me.

My cholesterol tends to be on the high side (though not high enough for medication). I am underweight thanks to my year of ulcerative colitis, which is now pretty much in remission thanks to Remicade. And about 15 years ago I was told that I *might* have "slight" fatty liver disease following a biopsy for crazy-high LFTs, but that's all and tests have been normal since then.

So....drug-induced autoimmune hepatitis? AIH? PSC? Fatty liver? Thoughts? Even just a "hey, chill out, whatever it is you can handle it" would help. Thanks.
--
F, 40. Diagnosed Feb. 8, 2017 - mild to moderate left-sided UC.
Finally off prednisone as of 5/15! Remicade 5mg/kg since 4/3/17.
Mesalamine intolerant. Started Zoloft 9/9/17.
Diet: dairy free.

ppm guy
Veteran Member


Date Joined Apr 2010
Total Posts : 1180
   Posted 12/10/2017 7:53 PM (GMT -6)   
hi fletch and welcome,
your ANA and ASMA are positive, suggesting an autoimmune issue. Your ulcerative colitis is also an auto immune disease. prednisone and immune suppressant drugs could mask AIH. Your biopsy will give your dr a lot of info.

if your dr suspects AIH, I would ask to be reffered to a hepatologist.

please let me know the results of your diagnoses. We have a moderator who has AIH, who could be very helpful

MamaLama
Forum Moderator


Date Joined Oct 2010
Total Posts : 4817
   Posted 12/11/2017 7:08 PM (GMT -6)   
hi fletch 10, welcome aboard the hep forum.

I agree with ppm guy, after biopsy, check with the hep docs.

I will send our AIH moderator a note so she knows to keep an eye out for your posts. She notes that with the proper med regimen, she manages her AIH with pretty much NO symptoms over the long haul. Few flares and a normal life...had a family, etc.

Best,
Mama Lama
MamaLama, Forum moderator - Hepatitis
Partner received liver transplant (May 1, 2011) FL
Hep C 1a Treatment - Sovaldi/Olysio (March - May 2014)
Undetected since week 4. Undetected 12 weeks post treatment.

Fletch10
Regular Member


Date Joined Feb 2017
Total Posts : 202
   Posted 12/11/2017 7:16 PM (GMT -6)   
Thank you both very much! Appreciate it. Trying hard to stay off Google smile Partially successful.
--
F, 40. Diagnosed Feb. 8, 2017 - mild to moderate left-sided UC.
Finally off prednisone as of 5/15! Remicade 5mg/kg since 4/3/17.
Mesalamine intolerant. Started Zoloft 9/9/17.
Diet: dairy free.

DGinSD
Forum Moderator


Date Joined Apr 2007
Total Posts : 848
   Posted 12/13/2017 12:59 PM (GMT -6)   
Hi Fletch!

So my AIH came after having the family and getting divorced but I have remained flare free since diagnosis almost 11yrs ago (Jan 18, 2007 to be exact). I’ve survived one lay off and am in another. Just got notice 6days ago. Yay! Ugh sad haha!
That was my rollercoaster right there!
ANA at 1:80 is super low on positivity. Most docs wouldn’t worry about that number. However, you’re on treatments which could mask things. I also wouldn’t worry about the levels of your LFTs. Some people after being ill have ‘new normals’, so that might be yours. Even with AIH flares they generally only get concerned when they are over 100.
Try not to stress out, easier said than done, as stress wreaks havoc on autoimmune conditions. When are your results expected? They will tell you what you need to know and let’s hope it’s nothing or just a blip from the UC!
Dany
Co-Moderator - Hepatitis
___________________________________________________
AIH Jan 2007
CMV June 2008
Raynaud's February 2010
Meds: Azathioprine 100mg & Ursodiol 250mg BID

Fletch10
Regular Member


Date Joined Feb 2017
Total Posts : 202
   Posted 12/13/2017 1:03 PM (GMT -6)   
@DGinSD - thank you so much! Your reply is very timely - I received a brief message from my GI (also a hepatologist) who said the results came back and "everything looks fine" - and that he wanted to chat later today. Not sure if his version of "fine" is the same as mine smile But I'm hopeful that means the biopsy was negative. I think he will want me to do an MRCP to rule out PSC, which he mentioned previously.

I'm hopeful that it's just a blip from the UC or the Remicade. Thank you so much and fingers crossed for good results.
--
F, 40. Diagnosed Feb. 8, 2017 - mild to moderate left-sided UC.
Finally off prednisone as of 5/15! Remicade 5mg/kg since 4/3/17.
Mesalamine intolerant. Started Zoloft 9/9/17.
Diet: dairy free.

DGinSD
Forum Moderator


Date Joined Apr 2007
Total Posts : 848
   Posted 12/13/2017 3:10 PM (GMT -6)   
Yay! Let’s hope the PSC is fine too smile
Dany
Co-Moderator - Hepatitis
___________________________________________________
AIH Jan 2007
CMV June 2008
Raynaud's February 2010
Meds: Azathioprine 100mg & Ursodiol 250mg BID

ocamo
Regular Member


Date Joined Jul 2017
Total Posts : 29
   Posted 12/26/2017 8:08 AM (GMT -6)   
Gentlemen, I'm new to this site. I have concerns that I might actually have AIH. I've had fatty liver for over a year. My ALT/AST are 19/21, ANA was 1:40 last year. Cholesterol is 202. My GI thinks there's a possibility. However, I feel great. Had a cold last week that lasted only 3 days. No pain, discomfort or any of the symptoms AIH patients experience pre diagnosis. So I'm wondering - is there something I should be looking for? Is it to soon to worry?

DGinSD
Forum Moderator


Date Joined Apr 2007
Total Posts : 848
   Posted 12/26/2017 10:17 AM (GMT -6)   
Ocamo,

I’m not sure why you or your doctor would think you have AIH based on your ANA or LFTs...all your numbers are normal. Work on getting your cholesterol under 200 and if you need to lose weight, try to lose weight. It certainly doesn’t sound like AIH. Stay away from alcohol if you want to be more kind to your liver since you have fatty liver.

Happy holidays!
Dany
Co-Moderator - Hepatitis
___________________________________________________
AIH Jan 2007
CMV June 2008
Raynaud's February 2010
Meds: Azathioprine 100mg & Ursodiol 250mg BID
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