Hepatitis Can Present with Jaundice and Deranged LFTs as the Only Symptoms
Yes, hepatitis can absolutely present with jaundice and deranged liver function tests (LFTs) without any other symptoms. This presentation is well-documented in various forms of hepatitis and represents a significant diagnostic consideration in clinical practice.
Pathophysiology and Clinical Presentation
Hepatitis can manifest with isolated jaundice and abnormal liver enzymes due to:
- Inflammation of the liver causing release of enzymes (elevated ALT/AST)
- Impaired bilirubin metabolism leading to jaundice
- Variable clinical presentation depending on etiology and host factors
Common Etiologies of Hepatitis with Isolated Jaundice and Abnormal LFTs
Viral Hepatitis
- Acute viral hepatitis (A, B, E) commonly presents with jaundice and elevated transaminases, often with ALT >1000 U/L 1
- Hepatitis A typically causes jaundice in 85% of adult cases, with elevated liver enzymes that may persist for up to 6 months 2
- EBV and CMV can cause prolonged hepatitis with jaundice 3
Autoimmune Hepatitis
- Can present acutely with jaundice and elevated liver enzymes as the only initial manifestations 4
- 40% of autoimmune hepatitis patients present with acute jaundice/hepatitis 4
Drug-Induced Liver Injury
- May present with isolated jaundice and abnormal LFTs without other symptoms 5
- Pattern of liver enzyme elevation can provide clues to etiology
Other Causes
- Alcoholic hepatitis
- Ischemic hepatitis (shock liver) 5
- Malignancy (including lymphoma) can occasionally present with isolated jaundice and abnormal LFTs 6
Diagnostic Approach
When encountering a patient with isolated jaundice and abnormal LFTs:
Assess pattern and degree of LFT abnormality:
- Hepatocellular pattern (predominant ALT/AST elevation)
- Cholestatic pattern (predominant alkaline phosphatase/GGT elevation)
- Mixed pattern
Consider viral hepatitis testing:
- Hepatitis A IgM (first-line in acute presentations) 1
- Hepatitis B surface antigen and core IgM
- Hepatitis E IgM (especially in certain geographic regions)
- EBV and CMV serology (particularly in younger patients)
Evaluate for autoimmune causes:
- Autoantibodies (ANA, SMA, LKM-1)
- Immunoglobulin levels (particularly IgG)
- Be aware that EBV infection can cause false-positive autoimmune markers 7
Assess for drug-induced liver injury:
- Detailed medication history (prescribed, over-the-counter, herbal)
- Timing of medication use relative to symptom onset 5
Consider imaging:
- Abdominal ultrasound is the first-line imaging modality 5
- May show hepatomegaly, gallbladder wall thickening, or other findings
Important Clinical Considerations
- Magnitude of enzyme elevation does not necessarily correlate with prognosis 5
- Repeated testing without investigation is not recommended - 84% of abnormal LFTs remain abnormal after 1 month and 75% remain abnormal at 2 years 5
- Watch for signs of liver failure - mental status changes and coagulation abnormalities require urgent evaluation 1
- Age impacts presentation - children often have asymptomatic hepatitis while adults more commonly have symptomatic disease with jaundice 2
Pitfalls to Avoid
- Assuming mild LFT abnormalities are benign - even mild elevations can indicate significant underlying disease 5
- Overlooking viral hepatitis in patients with autoimmune markers - viral infections like EBV can cause false-positive autoimmune markers 7
- Focusing only on common causes - consider rare etiologies like Wilson disease in young patients with acute liver failure 1
- Delaying diagnosis - early identification of the cause can prevent progression to cirrhosis in conditions like autoimmune hepatitis 4
In conclusion, isolated jaundice with abnormal LFTs is a well-recognized presentation of hepatitis from various etiologies. A systematic diagnostic approach is essential to identify the underlying cause and guide appropriate management.