Differential Diagnosis

The patient presents with elevated LDH, AST, and ALT levels, but normal WCC and CRP, and no symptoms of illness. Here's a differential diagnosis based on the provided laboratory results:

• Single most likely diagnosis
  • Muscle injury or strenuous exercise: Elevated AST and LDH can be seen in muscle injury, and ALT can also be elevated due to muscle damage. The lack of symptoms and normal inflammatory markers supports this diagnosis.
• Other Likely diagnoses
  • Hepatocellular injury: The elevation of AST and ALT suggests liver damage, which could be due to various causes such as viral hepatitis, autoimmune hepatitis, or drug-induced liver injury.
  • Hemolysis: Elevated LDH can be seen in hemolytic anemia, and AST can also be elevated due to the release of enzymes from lysed red blood cells.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Acute liver failure: Although the patient is asymptomatic, acute liver failure can present with elevated liver enzymes and should be considered to avoid delayed diagnosis.
  • Malignancy: Elevated LDH can be seen in various malignancies, and although it's unlikely, it's crucial to rule out cancer to avoid delayed diagnosis and treatment.
• Rare diagnoses
  • Wilson's disease: A rare genetic disorder that can cause liver damage and elevated liver enzymes, particularly in young adults.
  • Glycogen storage disease: A rare genetic disorder that can cause elevated liver enzymes and LDH due to muscle and liver damage.
  • Mitochondrial myopathies: A group of rare genetic disorders that can cause muscle damage and elevated liver enzymes.