Can measles cause transaminitis (elevated liver enzymes)?

Measles and Transaminitis

Yes, measles commonly causes transaminitis (elevated liver enzymes), particularly in adolescents and adults, with hepatic involvement occurring in 56-87% of cases. 1, 2, 3

Epidemiology and Clinical Patterns

Hepatic involvement in measles is age-dependent and significantly more common in adults than children:

• In adult patients, liver dysfunction occurs in 56-87% of cases, while pediatric patients (≤14 years) show less frequent and less extensive abnormalities 2, 3
• A significant correlation exists between age and transaminase elevation (r = 0.61 for AST, r = 0.56 for ALT) 3
• Recent data from Romania showed elevated AST in 87.3% and elevated ALT in 76% of hospitalized adult measles patients 1

Two Distinct Patterns of Hepatic Involvement

Measles-associated liver disease manifests in two clinically distinct patterns:

Pattern 1: Hepatocellular Dysfunction (Most Common)

• Characterized by aminotransferase elevation without jaundice 4
• Occurs in approximately 89% of cases with hepatic involvement (24/27 documented cases) 4
• Appears early during the eruptive phase of measles 1, 4
• Typically asymptomatic and self-limited 4, 3
• Resolves within a few days to 2-4 weeks 4, 3

Pattern 2: Cholestatic Pattern (Less Common)

• Characterized by cholestasis with clinical jaundice 4
• Occurs in approximately 11% of cases (3/27 documented cases in literature review, 12.7% in recent Romanian cohort) 1, 4
• Appears later, when measles symptoms begin to recede 4
• Persists for two weeks or longer 4
• May indicate more severe disease progression 1

Clinical Significance and Severity Markers

Cholestatic involvement serves as a marker of disease severity:

• GGT elevation shows significant correlation with severe clinical forms (p = 0.001) 1
• Jaundice occurred in only 5-12.7% of cases but was associated with more severe illness 1, 2
• Hepatic involvement correlates with secondary bacterial infections 2
• Most cases (77.5%) exhibit moderate clinical forms, while 22.5% have severe forms 1

Important Clinical Caveats

Antipyretic medication choice may influence hepatic involvement:

• Patients treated with paracetamol (acetaminophen) showed significantly higher rates of transaminase elevation compared to dipyrone (65% vs 15% for ALT, p<0.01; 58% vs 15% for AST, p<0.02) 5
• Mean transaminase and bilirubin levels were significantly higher in paracetamol-treated patients 5
• This occurred even with therapeutic doses of paracetamol (cumulative dose 11.6±5.8 gm in those with liver dysfunction vs 7.6±4.2 gm without, p=0.02) 5

Prognosis and Long-Term Outcomes

Complete resolution is the expected outcome:

• Long-term follow-up (up to 7 years) demonstrates complete resolution of liver damage 2
• All liver function parameters normalize within 2-4 weeks in the vast majority of cases 3
• No long-term hepatic sequelae have been documented 3

Key Clinical Pearls

• Do not dismiss transaminitis in measles patients as clinically insignificant - while often asymptomatic, it occurs in the majority of adult cases and correlates with disease severity 1, 2
• Monitor for cholestatic pattern - the presence of jaundice or elevated GGT suggests more severe disease and warrants closer monitoring 1, 4
• Consider avoiding paracetamol for fever management in measles patients given the association with higher transaminase elevations 5
• Expect complete resolution - persistent liver dysfunction beyond 4 weeks should prompt evaluation for alternative diagnoses 2, 3