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Persistent elevation of aspartate aminotransferase in a child after incomplete Kawasaki disease: a case report and literature review
BACKGROUND: Interpretation of abnormalities in liver function tests, especially in asymptomatic children, is a common problem faced by clinicians. Isolated elevation of aspartate aminotransferase may further puzzle physicians. Macro-aspartate aminotransferase (AST) results from complexes AST produce...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7025399/ https://www.ncbi.nlm.nih.gov/pubmed/32066411 http://dx.doi.org/10.1186/s12887-020-1975-8 |
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author | Rohani, Pejman Imanzadeh, Farid Sayyari, Aliakbar Kazemi Aghdam, Maryam Shiari, Reza |
author_facet | Rohani, Pejman Imanzadeh, Farid Sayyari, Aliakbar Kazemi Aghdam, Maryam Shiari, Reza |
author_sort | Rohani, Pejman |
collection | PubMed |
description | BACKGROUND: Interpretation of abnormalities in liver function tests, especially in asymptomatic children, is a common problem faced by clinicians. Isolated elevation of aspartate aminotransferase may further puzzle physicians. Macro-aspartate aminotransferase (AST) results from complexes AST produces with other plasma components, such as immunoglobulin. To our knowledge, this is the first report on a case of macro-AST-associated incomplete Kawasaki disease (KD). It is to make physicians aware of this benign condition and help to prevent extensive, unnecessary investigations and invasive workups. CASE PRESENTATION: A 16-month old boy with a 7-day history of fever was admitted to our pediatric ward for pyrexia workup. After complete investigations, KD was confirmed by a pediatric rheumatologist. During his admission and serial follow-up tests, an isolated AST elevation was noted. Comprehensive tests were performed and using the polyethylene glycol (PEG) precipitation method, macro-AST was confirmed. The patient has been followed up for 3 years, and so far, the benign nature of this condition has been confirmed. CONCLUSION: Clinicians should consider testing for macro-AST when elevated AST is the only abnormal lab finding. Although an uncommon finding, macro-AST may be seen in both children and adults. There are many reasons for this phenomenon, including resolved acute hepatitis or in some cases, inflammatory bowel disease, hepatic malignancy, monoclonal gammapathy, celiac disease, or KD; however, it may be observed in asymptomatic healthy children as well. Using the PEG precipitation method, a definitive diagnosis can be made. In none of these conditions does macro-AST have any prognostic significance. An appreciation of macro-AST may prevent the need for more invasive investigations to which patients may be unnecessarily subjected. It is important to recognize this condition as benign and assure patients that no specific treatment is required. |
format | Online Article Text |
id | pubmed-7025399 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-70253992020-02-24 Persistent elevation of aspartate aminotransferase in a child after incomplete Kawasaki disease: a case report and literature review Rohani, Pejman Imanzadeh, Farid Sayyari, Aliakbar Kazemi Aghdam, Maryam Shiari, Reza BMC Pediatr Case Report BACKGROUND: Interpretation of abnormalities in liver function tests, especially in asymptomatic children, is a common problem faced by clinicians. Isolated elevation of aspartate aminotransferase may further puzzle physicians. Macro-aspartate aminotransferase (AST) results from complexes AST produces with other plasma components, such as immunoglobulin. To our knowledge, this is the first report on a case of macro-AST-associated incomplete Kawasaki disease (KD). It is to make physicians aware of this benign condition and help to prevent extensive, unnecessary investigations and invasive workups. CASE PRESENTATION: A 16-month old boy with a 7-day history of fever was admitted to our pediatric ward for pyrexia workup. After complete investigations, KD was confirmed by a pediatric rheumatologist. During his admission and serial follow-up tests, an isolated AST elevation was noted. Comprehensive tests were performed and using the polyethylene glycol (PEG) precipitation method, macro-AST was confirmed. The patient has been followed up for 3 years, and so far, the benign nature of this condition has been confirmed. CONCLUSION: Clinicians should consider testing for macro-AST when elevated AST is the only abnormal lab finding. Although an uncommon finding, macro-AST may be seen in both children and adults. There are many reasons for this phenomenon, including resolved acute hepatitis or in some cases, inflammatory bowel disease, hepatic malignancy, monoclonal gammapathy, celiac disease, or KD; however, it may be observed in asymptomatic healthy children as well. Using the PEG precipitation method, a definitive diagnosis can be made. In none of these conditions does macro-AST have any prognostic significance. An appreciation of macro-AST may prevent the need for more invasive investigations to which patients may be unnecessarily subjected. It is important to recognize this condition as benign and assure patients that no specific treatment is required. BioMed Central 2020-02-17 /pmc/articles/PMC7025399/ /pubmed/32066411 http://dx.doi.org/10.1186/s12887-020-1975-8 Text en © The Author(s). 2020 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Case Report Rohani, Pejman Imanzadeh, Farid Sayyari, Aliakbar Kazemi Aghdam, Maryam Shiari, Reza Persistent elevation of aspartate aminotransferase in a child after incomplete Kawasaki disease: a case report and literature review |
title | Persistent elevation of aspartate aminotransferase in a child after incomplete Kawasaki disease: a case report and literature review |
title_full | Persistent elevation of aspartate aminotransferase in a child after incomplete Kawasaki disease: a case report and literature review |
title_fullStr | Persistent elevation of aspartate aminotransferase in a child after incomplete Kawasaki disease: a case report and literature review |
title_full_unstemmed | Persistent elevation of aspartate aminotransferase in a child after incomplete Kawasaki disease: a case report and literature review |
title_short | Persistent elevation of aspartate aminotransferase in a child after incomplete Kawasaki disease: a case report and literature review |
title_sort | persistent elevation of aspartate aminotransferase in a child after incomplete kawasaki disease: a case report and literature review |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7025399/ https://www.ncbi.nlm.nih.gov/pubmed/32066411 http://dx.doi.org/10.1186/s12887-020-1975-8 |
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