Persistent elevation of aspartate aminotransferase in a child after incomplete Kawasaki disease: a case report and literature review
Abstract 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...
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doaj-0ae080be13a24be4a76acac35b487aea2020-11-25T02:22:43ZengBMCBMC Pediatrics1471-24312020-02-012011510.1186/s12887-020-1975-8Persistent elevation of aspartate aminotransferase in a child after incomplete Kawasaki disease: a case report and literature reviewPejman Rohani0Farid Imanzadeh1Aliakbar Sayyari2Maryam Kazemi Aghdam3Reza Shiari4Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical SciencesPediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical SciencesPediatric Pathology Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical SciencesPediatric Research Institute for Children Health, Shahid Beheshti University of Medical SciencesPediatric Research Institute for Children Health, Shahid Beheshti University of Medical SciencesAbstract 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.http://link.springer.com/article/10.1186/s12887-020-1975-8Kawasaki diseaseMacro-ASTAspartate aminotransferaseChildrenPediatricLiver |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Pejman Rohani Farid Imanzadeh Aliakbar Sayyari Maryam Kazemi Aghdam Reza Shiari |
spellingShingle |
Pejman Rohani Farid Imanzadeh Aliakbar Sayyari Maryam Kazemi Aghdam Reza Shiari Persistent elevation of aspartate aminotransferase in a child after incomplete Kawasaki disease: a case report and literature review BMC Pediatrics Kawasaki disease Macro-AST Aspartate aminotransferase Children Pediatric Liver |
author_facet |
Pejman Rohani Farid Imanzadeh Aliakbar Sayyari Maryam Kazemi Aghdam Reza Shiari |
author_sort |
Pejman Rohani |
title |
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_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_sort |
persistent elevation of aspartate aminotransferase in a child after incomplete kawasaki disease: a case report and literature review |
publisher |
BMC |
series |
BMC Pediatrics |
issn |
1471-2431 |
publishDate |
2020-02-01 |
description |
Abstract 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. |
topic |
Kawasaki disease Macro-AST Aspartate aminotransferase Children Pediatric Liver |
url |
http://link.springer.com/article/10.1186/s12887-020-1975-8 |
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