Persistent elevation of aspartate aminotransferase in a chil
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Interpretation of abnormalities in liver function tests, especially in asymptomatic children, is a common problem faced by clinicians. Isolated elevation of aspartate aminotransferase may further puzzle physicians.

Clinicians should consider testing for macro-AST when elevated AST is the only abnormal lab finding. Although an uncommon finding, macro-AST may be seen in both children and adults.

This is the first report on a case of macro-AST-associated incomplete Kawasaki disease (KD).

A 16-month old boy with a 7-day history of fever was admitted to the pediatric ward for pyrexia workup. After complete investigations, KD was confirmed by a pediatric rheumatologist. During his admission and serial follow-up tests, an isolated AST elevation was noted. Comprehensive tests were performed and using the polyethylene glycol (PEG) precipitation method, macro-AST was confirmed. The patient has been followed up for 3 years, and so far, the benign nature of this condition has been confirmed.

Once the diagnosis of atypical KD was made, the patient was commenced on intravenous immunoglobulin (IVIG) therapy. Treatment protocol was 2 g/kg of IVIG over 12 h and 35 mg/kg of aspirin divided q6h for 48 h. According to the standard protocol, high-dose aspirin (80–100 mg/kg) should reduce to 30–40 mg/kg in patients with elevated liver enzymes. After 36 h, the patient’s fever subsided. Aspirin dose reduced to 3 mg/kg once daily orally until 6 wk. after illness onset.

There are many reasons for this phenomenon, including resolved acute hepatitis or in some cases, inflammatory bowel disease, hepatic malignancy, monoclonal gammapathy, celiac disease, or KD; however, it may be observed in asymptomatic healthy children as well. Using the PEG precipitation method, a definitive diagnosis can be made.