Macro-AST in an asymptomatic young patient

We report here the case of a 32 year old femalepatient with an isolated chronic asymptomatic ele-vation of the plasma ASAT. Our patient had no rele-vant past medical history and no family history ofliver pathologies. Anamnestically, abnormal liverfunction tests with a ten fold elevation of the tran-saminases were measured when she was 14, at thetime of an acute Epstein Barr Virus (EBV) infection.No follow-up controls of the liver function tests af-ter the healing from the EBV infection are available.The first observation of an isolated elevation ofthe ASAT (400 IU/L) in this patient was made 11years later, at the time of a systematic medicalcheck. Since then, several and regular controls ofthe liver function tests, over 7 years, confirmed theasymptomatic isolated elevation of the ASAT withvalues varying between 120 and 500 IU/L. Duringthis period, all additional explorations failed toidentify the cause of the ASAT elevation. The re-peated several viral serologies for hepatitis A, he-patitis B and hepatitis C were always unremarka-ble. Iron ferritin, transferrin, anti-nuclearantibodies, anti-mitochondrial antibodies, anti-glia-din antibodies, anti-transglutaminase antibodies,coeruloplasmine, TSH and abdominal sonographicimaging were unable to identify any liver disease asa possible cause of the ASAT abnormality. Duringthis period our patient was not taking any medica-tion except an oral contraception with an oestro-progestative pill she has been taking since the ageof 16. Stopping the oestro-progestative contracep-tion for 1 year in 2004 didn’t lead to any normali-sation of the ASAT values. The patient deniedtaking any herbal preparations or any other poten-tially liver toxic substances. So that a toxic or drugassociated liver damage was also considered as ra-ther unlikely. Before performing a liver biopsy andfurther investigations the patient was referred toour outpatient clinic.At this point and considering the unremarkablefindings, the negative physical examination, the nor-mality of the other liver function tests and the chro-nicity of the condition, a macroenzyme wassuspected and the ASAT activity was measured befo-re and after the addition of protein-A-sepharose, ac-cording to the method described by N. de Jonge, etal.