Pathology: Dermatomyositis

     Occasionally, the hepatologist is consulted for markedly elevated transaminase levels…that turn out to be secondary to a non-liver pathology.  In this case, a middle aged female was admitted to the liver service with AST > 1000 and ALT > 500.  There was an antecedent prodrome of vague symptoms including fatigue and muscle weakness.

     The patient also had a markedly elevated CPK (>20,000) and was subsequently diagnosed with dermatomyositis.  A photograph of her hands depicts a severe purpuric rash, consistent with this autoimmune entitiy. 

     The most common alternative source of elevated transaminase levels is skeletal muscle; in such cases CPK, LDH and aldolase levels can help confirm suspicions.  Other sources include the heart, kidneys, brain and red blood cells. 

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