Because his clinical condition had not improved, he went to the hospital, where he underwent medical tests such as complete blood count (CBC): hemoglobin 13.2 g/dL, hematocrit 39.6%, platelets 343,000/ [mm.sup.3], white blood cells (leucocytes 5200/[mm.sup.3]), liver function Aspartate transaminase
(AST) 39.8 U/L, Alanine transaminase (ALT) 40.1 U/L, gamma-glutamyl transferase (GGT) 346 U/L, and alkaline phosphatase 98.5 U/L.
Item Result White blood cells (/[micro](L) 6,800 Hemoglobin (g/dL) 14.0 Platelets(/[micro](L) 133,000 C-reactive protein (mg/dL) 34.30 Aspartate transaminase
(U/L) 79 Alanine transaminase (U/L) 38 Lactate dehydrogenase (U/L) 393 Creatine Phosphokinase (mg/dL) 307 Fe(/[micro]g/dL) 20 Ferritin(ng/mL) 1924
A comprehensive metabolic panel was remarkable for a glucose of 206 mg/dL (range, 74-99), potassium of 3.0 mmol/L (range, 3.5-5.3), bicarbonate of 16 mmol/L (range, 21-32), an anion gap of 30 mmol/L (range, 10-20), aspartate transaminase
(AST) of 466 U/L (range, 10-37), alanine transaminase of 374 U/L (range, 10-65), and serum total bilirubin of 1.9 mg/dL (range, 0.0-1.2).
There was a coinciding derangement in the liver function tests with gamma-glutamyl transferase (GGT) 589 IU/L (RR < 60 IU/L), alkaline phosphatase (ALP) 112 IU/L (RR < 55 IU/L), aspartate transaminase
(AST) 60 IU/L (RR < 55 IU/L), and alanine transaminase (ALT) 209 IU/l (RR < 45IU/L) which was attributed to critical illness.
Laboratory studies reported the following: hemoglobin 15.4 g/dL, leucocytes 7850/[mm.sup.3] (differential count: 4980 neutrophils/[mm.sup.3],1820 lymphocytes/[mm.sup.3],940 monocytes/[mm.sup.3], and 50 eosinophils/[mm.sup.3] without atypical cells), platelets 239000/[mm.sup.3], glucose 81 mg/dL, total cholesterol 109 mg/dL, triglycerides 179mg/dL, total bilirubin 12.07 mg/dL with 10.37 mg/dL of direct bilirubin and 1.70 mg/dL of indirect bilirubin, aspartate transaminase
(AST) 2050 IU/L (normal: 0-40IU/L), alanine transaminase (ALT) 2777 IU/L (normal: 0-41 IU/L), alkaline phosphatase 198 IU/L (normal: 40-130 IU/L) with gamma-glutamyltransferase (GGT) 105 IU/L (normal: 8-61 IU/L), and lactic dehydrogenase 960 IU/L (normal: 861 IU/L).
Liver function tests showed an alkaline phosphatase of 251 U/L, alanine transaminase of 71U/L, and aspartate transaminase
of 92 U/L.
Abdominal pain and hepatitis are common, with a higher elevation of aspartate transaminase
. Clinical response to antibiotics is excellent, with all the cases improving after 5 or 6 days of antimicrobial therapy, without the need of HLHspecific medications such as immunosuppressants or chemotherapeutic agents.
C-reactive protein (CRP) was 6.71 mg/dL (N [less than or equal to] 3.48), erythrocyte sedimentation rate (ESR) 8mm/h (N: 0-20), parathyroid hormone (PTH) 36.80 pg/ml (N: 12-88), serum creatinine (sCR) 0.81 mg/dL (N: 0.67-1.17), serum urea 46 mg/dL (N: 17-43), aspartate transaminase
(AST) 16.9 U/L (N: 0-50), and alanine transaminase (ALT) 19 U/L (N: 0-50).
Evaluations of plasma levels of acid phosphatase, alkaline phosphatase, alanine transaminase and aspartate transaminase
The results of biochemical analysis were as follows: Hemoglobin: 16.9 gr/dL, hematocrit 49.5%, platelet count: 319/m[m.sup.3], white blood cell count: 11.600/m[m.sup.3], coagulation values: normal, aspartate transaminase
: 119 u/L, alanine transaminase: 41 u/L, lactate dehydrogenase: 378 u/L, gamma glutamyl transferase: 203 u/L, sodium: 136 meq/L, potassium: 7 mmol/L, chlorine: 104 mmol/L, and calcium: 9.33 mg/dL.
The initial laboratory results revealed anaemia (haemoglobin 98 g/L), hepatic injury (aspartate transaminase
968 U/L, alanine transaminase 1520 U/L) and kidney injury (creatinine 147 [micro]mol/L).
The laboratory test results (Table 1A) showed that her creatinine phosphokinase, serum aspartate transaminase
, alanine transaminase, triglyceride, and cholesterol levels were elevated.