Fever elevated liver enzymes

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief:  Seyedmahdi Pahlavani, M.D. [2], Usama Talib, BSc, MD [3], Mahshid Mir, M.D. [4]

Synonyms and keywords: Fever and elevated liver enzyme, Fever and elevated LFT, Fever and elevated liver function tests, Elevated liver enzymes and fever, Elevated LFT and fever, Hyperthermia and elevated LFT, Hyperthermia and elevated liver enzymes.

## Differential diagnosis of Fever and elevated liver enzymes

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Conditions that can cause fever and elevated liver enzymes are presented in the table below, ordered based on their prevalence: [1][2][3]

Disease  | Clinical manifestations  | Laboratory findings  | Additional findings

|
|
|

Symptoms  | Signs  | Transaminitis (elevated AST and ALT)  | Viral markers  | Autoimmune markers
Nausea & vomiting  | Abdominal pain  | Arthralgia  | Jaundice  | Hepatomegaly
Acute viral hepatitis  | Hepatitis A | +++  | ++  | \+  | +++  | \+  | +++  | HAV Ab  | \
  |

* Fecal-oral transmission
* Usually acute and self limit
* Fever usually present

Hepatitis B | +++  | ++  | ++  | +++  | \+  | +++  | HBs Ag, HBc Ab, HBe Ag  | \
  |

* Percutaneous transmission most common
* May cause acute hepatic failure or may become chronic
* Fever usually present

Hepatitis C | +++  | ++  | ++  | +++  | \+  | +++  | HCV Ab  | \
  |

* Percutaneous transmission is most common
* Higher rate of chronic progression
* Associated with extra hepatic manifestation such as cryoglobulinemia and membranoproliferative glomerulonephritis
* Fever usually present

Hepatitis E | ++  | ++  | +/-  | ++  | \+  | +++  | HEV Ab  | \
  |

* Fecal-oral transmission
* May cause fulminant disease in pregnancy
* Fever usually present

CMV hepatitis | +/-  | ++  | \-  | \+  | \+  | ++  | CMV-specific immunoglobulin (Ig)M antibody  | \--  |

* Usually manifests as mononucleosis syndrome
* fever usually present

EBV hepatitis  | +/-  | ++  | \-  | +/-  | \+  | ++  | Heterophile antibody test, monospot test  | \--  |

* Systemic manifestations as mononucleosis syndrome
* Fever usually present

Autoimmune hepatitis  | \-  | \+  | +/-  | ++  | \+  | +++  | \
  | ANA, ASMA, anti SLA/LP, ANCA, ALKM-1 antibodies  |

* Liver biopsy may be required for diagnosis

Alcoholic hepatitis  | +/-  | \+  | \-  | \+  | \-  | AST>ALT | \
  | \
  |

* History of alcohol intake

Drug induced hepatitis  | +/-  | \+  | \-  | \+  | \+  | ++  | \
  | \
  |

* May cause either cholestatic or hepatocellular injury

## References

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1. ↑ Gilson R, Brook MG (2006). "Hepatitis A, B, and C". Sex Transm Infect. 82 Suppl 4: iv35–9. doi:10.1136/sti.2006.023218. PMC 2563900. PMID 17151052.
2. ↑ Heintges T, Niederau C (1993). "Differentiation between autoimmune hepatitis and hepatitis C virus related liver disease". Z Gastroenterol. 31 (5): 285–8. PMID 7686702.
3. ↑ Park JW, Kwak KM, Kim SE, Jang MK, Kim DJ, Lee MS, Kim HS, Park CK (2015). "Differentiation of acute and chronic hepatitis B in IgM anti-HBc positive patients". World J. Gastroenterol. 21 (13): 3953–9. doi:10.3748/wjg.v21.i13.3953. PMC 4385543. PMID 25852281.