Puzzling Liver Issues

I first posted to this board in December when I thought I might have AIH because my liver enzymes became elevated immediately after delivery of my triplets (numbers were normal throughout the pregnancy).  Since then, I have had many blood tests and  the numbers have been running as follows on each of my tests:

ALT: 199-223

AST: 75 - 130

ALP: 115-150

GGT: 150 - 175

All other values are in normal range and unremarkable and all autoimmune testing has come back negative (except for one weak poitive ANA of 1:80 in December which is now negative).

Well, fast forward to today and I am more confused as ever.  In that time I have also had an ultrasound (normal), an MRCP (normal) and finally a liver biopsy.  The only thing my biopsy even hinted at was "possible" drug induced liver injury - which was slight.  No other disease process going on.  But here is the puzzling thing.  I rarely took any medicines before my pregnancy other than Synthroid (although I had to take niphedipin and magnesuim sulfate and steroids while pregnant).  After my c-section, I took the standard ibuprofen/tylenol prescribed to me for about two weeks but never exceeded my daily maximum and while I didn't drink at all throught the pregnancy, I had a few glasses of wine in the two months after delivery, but before I knew I had liver issues).  And that's it.  I stopped all medication (including vitamins) and have not had a single drink since late November, but my enzyme levels have not declined.  If it was drug induced, wouldn't they have already?

My GI is puzzled.  My hepatologist at  Mt. Sinai in NYC (a reputable liver center) is puzzled.  I had my biopsy slides reviewed by two separate pathologists (both local and at Mt. Sinai) and they both came up with the same conclusion. So the plan for now is just to follow me and keep taking tests every 3 months until something changes and to take no drugs, supplements or alchohol.  I'm sure no one on here can guess what is going on, but maybe someone might have some insight as to how I can lower these enzymes naturally before I have long lasting damage.  I seem to be running into a lot of dead ends.

Hi cookie Chick!
Sorry it took so long to write back. Carol emailed tonight and I knew I forgot to write but when I logged in my lightbulb went off. I tried to log in earlier from work but they are upgrading our wifi and I had trouble connecting. So part of my head thought I had written back.

Anywho, I'm sorry they haven't sorted out what's going on. Have they done a HIDA scan to make sure everything is flowing through your gallbladder properly? If not, I'd request one.

Carol had a good thought...sometimes with AIH, it's so hard to diagnose that some heps will just try prenisone and if it works to get your LFTs in normal range, that helps with diagnosis. AIH is the only one that will respond to pred.

It is possible that your issue started as a drug-induced hepatitis and has triggered AIH but your antibodies don't reflect it yet.

I had the same issues as you are having. so may of my test including a liver biopsy were inconclusive. As the numbers continued to climb I was referred to a hepatologist. I had already had a liver panel done and a biopsy before i was refereed to Pittsburgh liver cancer. My first visit my liver biopsy slides hadn't arrived yet. It was decided they would do some more blood work and have me come back in 6 weeks. I went back in the 6 weeks and was told my liver enzymes had fallen down close to normal that we would just watch and see where they went. More blood was taken before i left that day. Later that evening I got a call from my hep, the numbers were up again. he said I'm being very truthful with you I'm just not sure what we are dealing with. He wanted to start me on 30mg predisone and see if it brought them down. after a month they added the aza. I was told it takes the Aza at least 3 months to kick in, with in those 3 month the numbers were still dropping but slowly. after the third month of pred and aza the numbers started to drop quickly. I'm now tapering off the pred, just have to see how things go from here. My last appointment he told me he feels we are headed in the right direction. I'm guessing they caught me in the early stages of the disease. They caught my high enzymes in a blood test at my annual check up. I don't have any damage that can't be reversed with the treatment.
as to what triggered the AIH we have no idea.

@ugpred

Thanks for posting in..I see this is your first time posting here

Welcome and thanks...the latest time between onset of symptoms and proper diagnosis can bring rough for aihers. Sounds like you are in good hands. Come see us again or start a thread if your own.