Can measles cause elevated liver function tests (LFTs) in patients, particularly those with underlying liver conditions or in pediatric patients and young adults with no significant past medical history?

Measles and Elevated Liver Function Tests

Yes, measles commonly causes elevated liver function tests, particularly in adults, with hepatic involvement occurring in 56-80% of cases through direct viral infection of hepatocytes. 1, 2

Frequency and Pattern of Liver Involvement

Measles-associated hepatitis is substantially more common and severe in adults compared to children:

• In adults (>14 years): Liver dysfunction occurs in 56-80% of cases, with abnormal transaminases being the predominant finding 1, 2
• In pediatric patients (≤14 years): Hepatic involvement is less frequent and less extensive, with a significant age-dependent correlation (r = 0.61 for AST, r = 0.56 for ALT) 2
• Clinical jaundice develops in only 5% of cases, making most hepatitis subclinical 1, 3

Mechanism of Liver Injury

Measles causes hepatic damage through direct viral infection of liver cells:

• Direct viral hepatocellular injury: Measles virus RNA has been detected in liver tissue by RT-PCR, confirming direct viral invasion of hepatocytes 4
• Histopathology shows slight necrosis of liver cells without significant portal area changes, though virus particles are not typically visible on electron microscopy 4
• Secondary bacterial infections correlate with more severe hepatic involvement, suggesting an additional inflammatory component 1

Clinical Presentation Patterns

Two distinct patterns of measles-associated hepatobiliary disease exist:

Pattern 1: Hepatocellular (Most Common)

• Characterized by: Elevated aminotransferases (AST/ALT) without jaundice 5
• Timing: Appears early in disease course, peaks between days 5-10 1
• Clinical course: Typically asymptomatic, resolves within 2-4 weeks 5, 2
• Frequency: Occurs in 24/27 documented cases in literature review 5

Pattern 2: Cholestatic (Rare)

• Characterized by: Cholestasis with clinical jaundice 5
• Timing: Becomes apparent as measles rash begins to recede 5
• Duration: Persists for 2 weeks or longer 5
• Frequency: Only 3/27 cases in comprehensive literature review 5

Important Medication Consideration

Antipyretic choice may significantly impact hepatic injury severity:

• Paracetamol (acetaminophen) use during measles is associated with significantly higher rates of transaminase elevation (65% ALT, 58% AST) compared to dipyrone (15% for both enzymes, p<0.01) 3
• Mean transaminase levels were significantly higher in paracetamol-treated patients (AST 92±86 vs. 42±49 IU, p<0.02) even at therapeutic doses 3
• Cumulative paracetamol dose correlated with liver dysfunction (11.6±5.8 gm vs. 7.6±4.2 gm in those without liver damage, p=0.02) 3

Prognosis and Long-term Outcomes

Measles-associated hepatitis has excellent long-term prognosis:

• Complete resolution occurs in all cases, with liver function tests normalizing within 2-4 weeks 1, 2
• Long-term follow-up (up to 7 years) demonstrates complete resolution of liver damage with no chronic sequelae 1
• No progression to chronic liver disease has been documented 2

Clinical Management Implications

When evaluating elevated LFTs in measles patients:

• Expect transaminase elevations in the majority of adult patients, particularly those with more severe systemic illness 1
• Monitor for secondary bacterial infections as these correlate with more severe hepatic involvement 1
• Consider avoiding paracetamol for fever management given the association with higher transaminase levels 3
• Reassure patients about the self-limited nature and excellent prognosis of measles-associated hepatitis 1, 2
• Follow liver function tests to document normalization within 2-4 weeks 2