Brief Answer:

Complicated.

Detailed Answer:

Hello,

first of all, I'd like to see every test you've done so far (the reports I mean). Please do not write them down, I'd like the reports themselves. If you don't have a scanner you can use your cell phone or a digital camera to take a picture - please make sure they're readable though.

Your case sounds complicated. You do have some positive tests that could indicate disease but the tests are not diagnostic. Please also provide more information by answering the following questions:

- Have you done tests in the past? For example, did you have blood in your urine 1 or 2 years ago? What about the rest of the tests?

- Your body weight and height

- Did you feel OK at any time during these 3 weeks or were the symptoms constant or worsening?

- Do you drink alcohol or take any drugs besides the ones you've mentioned? Any supplements?

- History of renal stones or renal colic?

- Urinary tract symptoms, like urgency, flank pain, burning pain on the urethra or testicular discomfort?

- Are your bowel movements normal? (as they used to be in the past).

- Have you had a fever at any time during the last 3 weeks? Have you checked with a thermometer?

Hope I have answered your query. Let me know if I can assist you further.

Take care

Regards,
Dr Panagiotis Zografakis, Internal Medicine Specialist

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Brief Answer:

Some tests missing.

Detailed Answer:

Hello,

You've mentioned ANA, ALT (SGPT), bilirubin, etc in your first text that I've not seen in the attachments.

The reason I wanted to see the reports was to get to know what kind of tests you've done so far and the reference range for tests like SMA or ALT since different labs may have different ranges.

So it seems that you have a low ANA titer, a fluctuating ALT (SGPT) with values less than three times the highest normal value, lower abdominal discomfort, and hematuria.

You have (or had) a fever probably and general (and vague) symptoms like fatigue and nausea.

Since you had blood in the urine in the past, I tend to believe that this is not related to your current situation. An evaluation is required though, starting with an ultrasound scan of the urinary tract.

Regarding your abdominal discomfort, the negative CT scan excludes serious causes like diverticulitis with abscess formation but it does not exclude intraluminal causes. On the other hand, the lack of diarrhea is very much against intestinal disorders.

You haven't mentioned the presence of fat in the liver but I haven't seen the report either so I'm not sure whether there is fat or not.

Fat in the liver may account for mild transaminase elevations particularly in patients with increased body mass index, diabetics or individuals who drink much alcohol.

Positive ANA with mild transaminase elevations may raise suspicion for type 1 autoimmune hepatitis.

There is no diagnostic test for this type of hepatitis, so excluding other potential causes is important here.

Drugs, toxins, various infections may cause mild elevations of transaminases as well and they're far more common than autoimmune hepatitis. This is something to consider though if nothing else comes up in the diagnostic process.

Finally a comment for other potential causes.

The possibility of fever (general symptoms, feeling feverish and then sweating) is more than considerable and I cannot really understand how you did all those tests without testing your temperature.

You've done a CT scan and various 'advanced' tests (antibody testing both for infectious and autoimmune causes) without checking for fever? I wouldn't understand that from your doctor's perspective either!

Anyway, the fever usually means infection. Various infections may cause such vague symptoms and they may also raise the transaminases a bit (if they were not high before the symptoms).

I could not suggest any particular infection as there are no data to do so. Let me add though that normal CRP and low ESR exclude active infection at the time they were done. Regarding various types of malignancies (much less common):

So far I know that you have a negative CT scan and I gather that your doctor examined you and checked for enlarged lymph nodes and other important parameters, so I would consider the malignancy scenario less likely.

So in conclusion, I'm not sure that all your symptoms or findings are related to one disorder. For some of your symptoms, I would require more testing (like serum electrolytes values or renal function indices).

Hope I have answered your query.

Take care

Regards,
Dr Panagiotis Zografakis, Internal Medicine Specialist

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