CASE HISTORY Kambiz Bral, M.D.
B.P., a 35-yr-old black woman, was referred in December 1989 for evaluation of asymptomatic elevation of liver enzyme levels detected during a check-up for possible kidney donation to her sister, who had end-stage kidney failure due to lupus nephritis, She had no history of jaundice or hepatitis but said she had tired easily for the past 3 or 4 yr. She had no history of joint pain or skin rash.
The patient's past health was good. She is married and has had two children. She had never received transfusions of blood or blood products. The only surgical procedure she had undergone was a hysterectomy, in 1984. She denied intravenous drug use. B.P. had previously had an average of one drink a week, but she stopped drinking when she was found to have elevated liver enzyme levels. She was not taking any medication. In addition to her sister, one first cousin also had systemic lupus erythematosus (SLE). No family history of liver disease existed.
Examination revealed no facial rash or joint swelling. No stigmata of chronic liver disease were present, and no hepatosplenomegaly was found. Urinalysis showed no protein and no RBCs or casts.
Blood tests showed a hemoglobin level of 12.7 gm/dl (normal, 12 to 14 grddl); WBC count of 3.8 x 103/pl (normal, 4.5 to 11 x lo3); platelet count of 250 x 103/pl (normal, 160 to 420 x lo3); BUN of 15 mg/dl (normal, 5 to 20 mg/dl); creatinine of 1.0 mg/dl (normal, 0.7 to 1.2 mg/dl); albumin of 4.2 gm/dl (normal, 3.7 to 5 gm/dl); globulin of 4.3 gm/dl (normal, 2.6 to 3.2 gm/dl); total bilirubin of 0.5 mg/dl (normal, < 1.1 mg/dl); alkaline phosphatase of 93 U/L (normal, 40 to 120 U/L); AST of 83 U/L (normal, <39 UL); ALT of 130 U/L (normal, <41 U/L); prothrombin time of 11.1 sec (control, 12 sec); no HBsAg, HBs antibody, HBc antibody, antinuclear antibody (ANA), smooth muscle antibody (SMA), antimitochondrial antibody (AMA) or rheumatoid factor (RF); ceruloplasmin of 42 mg/dl (normal, 15 to 60 mg/dl); ferritin of 71