Acute Non Viral Hepititis

Hello all.

Here is my situation...or my wife's actually. She had her annual check-up with her primary and explained that she was experiencing anxiety while driving and seasonal depression during the winter. The PCP recommended an anti-depressant, which she began on Nov 11th. Among the noted drug side-effects were fatigue, nausea and random itchiness. During the first 3 weeks she had experienced all of these symptoms, but chalked it up to medication adaption period. By the start of the 3rd week, she had grown frustrated and had decided to give up on the drug unless she started to feel better....which she did for 2-3 days.

Then her symptoms snapped back and even more severe. She did not vomit, but was even more nauseous and fatigued. After a couple days, while still on the meds, she felt discomfort in her abdomen. And the next day noticed the corner of her eyes were yellow in color. She call her PCP who instructed her to immediately stop the meds and come in for an appt the same day. After the visit, the PCP wrote a stat blood screen and an ultrasound script at the outpatient facility of our nearby hospital. After both, she was immediately admitted to the ER. The US showed that her gall bladder was inflamed and the bloodwork that her liver enzyme counts were thru the roof: ALT/AST around 1700/1500. The next day she had an MRI which revealed hepatitis. They repeatedly asked her the questions about IV drug use, tattoos, etc. None of which were applicable. We kept pointing back to the meds and I pulled up some posts of related hep instances to the drug.

The GI doc initially stated there was no real treatment for the condition and she was either going to heal or may need a transplant. The GI doc has an extensive pedigree, Columbia, U of Pitt, etc. They kept her in the hospital for a about a week. Each day her enzymes would drop a bit...about 80 points per day. Her INR was as high as 1.49 and her billi around 7.5. After the week, and a battery of tests, the doc said he felt she had turned the corner and that there would not be any long term issues. He also confirmed it was an adverse reaction to the meds. They then discharged her.

She has been out since Dec 15th and she had blood work on the 17th. Her ALT/AST was 1100/1100. Her INR was 1.3, but her bili was up to 9.5. She is obviously still jaundice, but continues to have some nausea and fatigue as well. Was wondering if any one had a similar situation with either Tylenol, supplements or other drugs. And, if they could share their recovery experiences. The hardest part of this is trying to get comfort that things are indeed getting better. Outside of the enzyme numbers slowly decreasing and the INR holding or decreasing, she looks and feels the same. I totally get that this will be a long process given how much damage she sustained.

Thanks in advance.

Post Edited (Chris F) : 12/19/2015 1:37:39 PM (GMT-7)

also , liver damage is reversible, once they stop the inflamation.

Thank PPM Guy & TheMiz.

@PPM Guy, the attending GI doctor is also a Hepatologist (failed to mention). In fact, he was Chairman of the Division of Hepatology and the medical director of the liver transplant program at Einstein Hospital in Philly. Early on they were really focused on viral Hep and after the tests came back negative, they began to consider the meds as the cause. I think by way of ruling everything else out, they landed on the an adverse reaction to the meds. They were telling us that it was < 1% chance of this happening.

The docs never really went thru the tests in any real detail, just that they all had come back negative. I just went back thru the discharge paper work.

ANA was Neg
Mitochondria M2 Antibody was Neg, 6.5 U
Soluble Liver Anitgen IgG Antibody was Neg, 2.6 U
SMA was Neg, 9 U
Liver / Kidney Microsomes Anitbody was Neg, .9 U
Hep A, B, C was Neg

Also, she is young, will be 40 in a few months. Is not overweight and does not smoke. She may have one or two glasses of wine per week.

Edit: Also adding that they did put her on an IV of Acetylcysteine which is used for the treatment of Tylenol over dose. The doc stated that this was not really a treatment, but MAY help the liver along. She was put on it about 48 hours after being admitted for about 4 days.

Post Edited (Chris F) : 12/19/2015 7:09:57 PM (GMT-7)

That makes sense..
Glad you got it before it got out of control
Barry

Hi Chris F.
Absolutely agree with AIHer.
This has all the "earmarks" of an idiosyncratic drug reaction.
Great news that she is on the mend all by herself. Sometimes the best medical treatment is quite simply, "tincture of time"...but it's tough for the patient and family to wait it out...feeling like nothing is being done.

I also like that she is receiving some "supportive" treatment
...aka the IV Acetylcysteine.
Sounds like her doc is doing everything right...although his/her initial consult could have been a bit more patient/family friendly.
My guess is that she'll recover completely.
Our thoughts and prayers are with you both.

___________________________________________

2013 / Diagnosed and successfully treated for hep c geno 1b with Telaprevir, Interferon and Ribavirin...treatment duration 24 weeks.
Retired CRNA (aka nurse anesthetist)...approx 35 years experience in the ER and anesthesia.
Exposure was likely a bloody needle stick from a known hep b patient in 1977. Hep B never progressed to the chronic phase...my own, healthy immune system crushed it.

Post Edited (woofer5) : 12/20/2015 9:40:20 PM (GMT-7)

Hi Chris. I haven't checked in so sorry for the delayed reply. You wife's symptoms sound similar to my son's (he turned 18 earlier this month). He was tested for everything you can be tested for at least 3 or 4 times last year and it all came back negative. His AST and ALT levels were 2000 to 3000. Then he started to get better on his after 4 weeks in the hospital. They were just watching him basically and preparing to put him on the transplant list. He was released and a month later they started to climb again. Last fall they put him on prednisone just to see what would happen. It put his LFTs back to normal pretty quick. He has since been diagnosed with AIH based on his response to the prednisone and 6-MP. I understand how frustrating it can be. You guys hang in there. Keep following up, doing your own research and ask questions!

Post Edited (AutoHepMom) : 3/24/2016 6:05:06 PM (GMT-6)