Differential Diagnosis for Elevated Alk Phos and Positive ANA

• Single Most Likely Diagnosis
  • Systemic Lupus Erythematosus (SLE): This is a common autoimmune disease that can cause elevated alkaline phosphatase (alk phos) levels due to liver involvement and is often associated with a positive antinuclear antibody (ANA) test.
• Other Likely Diagnoses
  • Rheumatoid Arthritis (RA): Although primarily known for joint involvement, RA can also affect the liver, leading to elevated alk phos, and may have a positive ANA.
  • Sjögren's Syndrome: An autoimmune disorder that can affect the liver and is associated with a positive ANA, potentially leading to elevated alk phos.
  • Primary Biliary Cholangitis (PBC): A chronic liver disease characterized by the destruction of bile ducts within the liver, leading to elevated alk phos, and can be associated with a positive ANA.
• Do Not Miss Diagnoses
  • Wilson's Disease: A rare genetic disorder that leads to copper accumulation in the liver, causing liver damage and potentially elevated alk phos. A positive ANA can be seen due to the autoimmune nature of the disease. Missing this diagnosis could lead to severe liver damage.
  • Autoimmune Hepatitis: A disease where the body's immune system attacks liver cells, leading to inflammation and potentially elevated liver enzymes, including alk phos. It is often associated with a positive ANA and can be severe if not treated.
• Rare Diagnoses
  • Mixed Connective Tissue Disease: A rare autoimmune disorder that combines features of lupus, scleroderma, and rheumatoid arthritis, and can cause elevated alk phos and a positive ANA.
  • Sarcoidosis: A condition where inflammatory cells form lumps known as granulomas in various parts of the body, including the liver, potentially leading to elevated alk phos. While ANA can be positive, it's less common than in other autoimmune diseases.