P1913 - An Uncommon Presentation of Elevated Liver Function Tests

Ghady Ali M. Moafa, MD¹, Divyesh Nemakayala, MD¹, Hrishikesh Samant, MD^2
1Ochsner Clinic Foundation, New Orleans, LA; ²Ochsner Medical Center, New Orleans, LA

Introduction: The most common causes of elevated liver function tests (LFTs) are nonalcoholic fatty liver disease and alcoholic liver disease. Uncommon causes include drug-induced liver injury, hepatitis B and C, and hereditary hemochromatosis. Rare causes include alpha1-antitrypsin deficiency, autoimmune hepatitis, and Wilson disease. Extrahepatic sources, such as thyroid disorders, celiac sprue, hemolysis, and muscle disorders, are also associated with mildly elevated transaminase levels.

Case Description/Methods: A 61-year-old female with a history of Chronic lymphocytic leukemia (CLL) diagnosed in 2014 with confirmed remission for at least 7 years presented to the Hepatology clinic for evaluation of elevated LFTs. Extensive serological workup was negative. Ultrasound imaging showed hepatomegaly. Fibroscan showed K3 fibrosis kPa 10.3. MRI abdomen elastography showed liver fat fraction measures 16 %, consistent with mild steatosis (Figure 1). Liver elasticity measures 3.83 KPa consistent with F1 or F2 fibrosis.

She underwent a liver biopsy which showed stage 3 fibrosis as well as chronic lymphocytic leukemia/small lymphocytic lymphoma predominantly CD20-positive B-cells. The B-cells are positive for CD5, CD23, BCL2 and LEF1, negative for CD10, BCL6, cyclin D1 and SOX11, the proliferation index (Ki-67) is low. CD3-positive reactive T-cells are seen. There was no morphologic evidence of large cell transformation. A multidisciplinary consensus was made to monitor her labs with no further treatment of her CLL at this time.

Discussion: Chronic lymphocytic leukemia (CLL) is the most commonly diagnosed leukemia in the U.S. Can involve different sites in the body including Spleen, and also Lymph nodes. Physicians should be aware of different uncommon presentations and sites of involvement that are possible in CLL. Here we presented a case of liver involvement to increase awareness.


Figure: Fig. 1: The showed liver fat fraction measures 16 %, consistent with mild steatosis. Liver elasticity measures 3.83 KPa consistent with F1 or F2 fibrosis.


Disclosures:
Ghady Ali Moafa indicated no relevant financial relationships.
Divyesh Nemakayala indicated no relevant financial relationships.
Hrishikesh Samant indicated no relevant financial relationships.


Ghady Ali M. Moafa, MD¹, Divyesh Nemakayala, MD¹, Hrishikesh Samant, MD². P1913 - An Uncommon Presentation of Elevated Liver Function Tests, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.