P2465 - A Case of Elevated Liver Enzymes in a 20-Year-Old Primigravida

Priya Karthikeyan, MD¹, Deena Kapadia, MD^2
1HCA Medical City Arlington, Arlington, TX; ²Medical City Dallas, Dallas, TX

Introduction: Hyperemesis gravidarum (HE) is a condition, which can cause aminotransferases to be elevated up to 200 U/L, occurring in the first trimester of pregnancy. This condition causes a broad range of clinical signs and symptoms, including severe nausea and vomiting, elevated lipase, electrolyte abnormalities, and elevated liver enzymes. Liver enzyme derangement to the 1000s is rare in HE. This case had an unusual presentation of HE and responded to a different treatment modality that is not typically seen. This case provides a basis for management of similar patients with elevated liver enzymes in the setting of HE.

Case Description/Methods: Our case describes a 20-year-old primigravida, 12 weeks pregnant with twins on initial presentation, who was admitted for nausea, vomiting, and elevated liver function tests. Initial labs were T.bili 1.1, AST 888, ALT 1744, ALP 98, albumin 3.5, INR 1.241, lipase 1016 (Table 1). Extensive history revealed no elevated risk factors for Hepatis B and Hepatitis C. Extensive lab work up was done to evaluate autoimmune and infectious etiologies, all of which were negative. Abdominal ultrasound and MRI of the abdomen were unremarkable for acute liver abnormalities. Patient received N-acetylcysteine (NAC) until liver enzymes were < 1000. She received IV TPN to ensure she received adequate nutrition as she could not tolerate PO intake. Her electrolyte derangements were corrected through IV replacement. She showed improvement with liver enzymes, but values worsened again during hospital course, prompting a liver biopsy. The results showed non-specific inflammation with possible healing/healed infection or a drug induced liver injury. She was placed on NAC again, ursodiol, steroids and vitamin B6 for treatment of HE. Liver enzymes down-trended, and she was discharged on steroid taper and ursodiol with outpatient follow up. At her follow up appointment with hepatology, her blood work showed improvement in her AST, ALT, ALP, and T-Bili.

Discussion: This case demonstrates a young primigravida, who presented with severe elevations of her liver enzymes in the context of nausea and vomiting. There are few other cases describing a similar treatment modality given to this patient. Her treatment with NAC, ursodiol, and steroids resulted in improvement in her liver enzymes. This case will help to understand the effects of treating elevated liver enzymes in patients with HE.


Disclosures:


Priya Karthikeyan, MD¹, Deena Kapadia, MD². P2465 - A Case of Elevated Liver Enzymes in a 20-Year-Old Primigravida, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.