Serum aminotransferases, as the most sensitive marker for acute liver injury, in this patient was

elevated. Other than liver, it distributes to cardiac muscle, skeletal muscle, kidney, brain, pancreas,
lung, leucocyte, and erythrocytes. ALT is more spesific marker for evaluation of liver injury than AST.
This patient’s symptoms were fever and nausea, but no liver enlargement, jaundice, abdominal
tenderness were detected from physical examination. We suggest additional laboratory studies, such
as gamma GT, bilirubin, and alkaline phosphatase, are needed to confirm whether hepatitis or other
causes made elevation of these enzymes. Other than hepatotrophic viruses, hepatitis can also caused
by systemic viral infections such as cytomegalovirus, enteroviruses, coxackievirus, arbovirus,
adenovirus, herpes simplex virus, Epstein-barr virus, HIV, rubella, varicella zoster or non-viral liver
infections such as tuberculosis, histoplastomosis, leptospira, abcesses, amebiasis, bacterial sepsis, etc.
Spesific etiology in this patient has yet to be determined.1

1. Kang KS. Abnormality on liver function test. Pediatric gastroenterology, hepatology &
nutrition. 2013;16(4):225-32.