Many different viruses can cause abnormal liver tests and at this time of year. As we are in the midst of “flu season”, we are seeing many people with unexplained, very high liver tests. Most people are familiar with the common types of viral hepatitis, aptly named hepatitis A, B, C, D and E. While these are best known, there are many other viruses which can cause hepatitis and are important to be aware of. Almost all viruses can cause mild, transient elevations in liver enzymes including the viruses that cause the common cold. Some viruses may even cause liver tests to become markedly elevated or cause jaundice. It is rare for these viruses to cause liver failure.
Coronavirus has been in the news lately secondary to the outbreak of a novel coronavirus in Wuhan, China. It is important to know that coronaviruses are commonly seen in our area and these viruses can cause abnormal liver tests. These coronaviruses are not the novel coronavirus being described out of China. Whether or not this new, novel coronavirus causes hepatitis remains to be seen. So far, it appears to primarily affect the lungs.
Adenoviruses are a common cause of bronchitis, pneumonia, conjunctivitis and gastroenteritis. Enteroviruses are common in our area and typically cause upper respiratory systems with fever and conjunctivitis. Coxsackie viruses, common amongst children in summer camps and pools, may also cause a variety of complaints ranging from stiff neck to cough to chest pain to rash to diarrhea. Rotavirus is a common cause of gastroenteritis in children. All of these viruses cause mild liver test elevations which return to normal with recovery.
Most people infected with these types of viruses listed above do not seek medical care for their complaints. They usually just wait it out. Some, however, will seek medical care and routine blood tests commonly show abnormal liver tests. These findings do not mean that liver damage has occurred or that a further evaluation is necessary at that time. The common-sense approach would be to wait for the symptoms to get better and then repeat the blood tests. Don’t forget, many people will also have abnormal blood tests because they took over-the-counter medications such as acetaminophen, non-steroidals, etc. or health store products or old antibiotics that were lying around in the cabinet in the hopes of making themselves feel better. In the vast majority of people, after an appropriate wait, liver enzymes will return to normal.
Infectious mononucleosis or “mono” is a disease primarily of teenagers and young adults 15 to 25 years of age. It is caused by the Epstein-Barr virus. It is especially common in schools, camps, hospitals and military areas. The transmission of this virus is by close personal contact such as such the transfer of saliva during kissing. Once infected, the duration of the disease can vary tremendously from a few days to a few weeks. It usually starts with fatigue, sore throat, a high evening fever and enlarged, tender lymph nodes in the neck area. Over time, an enlarged liver and/or spleen may develop associated with a rash and swelling of the areas around the eyes. Liver enzymes may be dramatically elevated but diagnosis is based solely on determining the presence of antibodies in the blood to the Epstein-Barr virus. There is no treatment for mononucleosis other than supportive care including drinking plenty of fluids. Liver test abnormalities quickly resolve with clearance of the virus. Classically, people with mononucleosis may become jaundice if given antibiotics. There are no long-term deleterious effects in the liver related to this infection.
The liver is the largest organ in the body and therefore potentially affected by any systemic infection such as viruses. Appropriate viral testing, when indicated, may help determine the cause although many times the causative agent cannot be identified. It is important to reassure the infected person that most of the viruses causing hepatitis are self-limited, usually benign infections.
David Bernstein is chief of gastroenterology, hepatology and nutrition at North Shore University Hospital and Long Island Jewish Medical Center.
Good timing for this article.
My 22 y.o. son had a fever that started Christmas Eve and persisted. After two weeks of feeling pretty crummy (and missing work), he went to the doctor, and they did a full blood panel which came back with very high liver enzyme numbers (over 600 each).
After another 8 vials of blood and an ultrasound (enlarged spleen), it was determined that he had “double mono”: active EBV and CMV infections. It was surprising, since he had already had mono (EBV) when he was 15. However, testing also indicated an underlying autoimmune disorder (both my sister and I have lupus, so he’d come by it honestly), and between that and the stress of his holiday work schedule (18 days without a day off), it was just too much for his compromised immune system.
Like the first time he had it, the mono flattened him for more than seven weeks. No fun!