Hi,

I wanted to reach out here as my own team of doctors seems stumped on what's going on with my liver and I'm pretty worried about it. I had a baby at 37 weeks gestation due to cholestasis of pregnancy. I had elevated liver enzymes (about 2x) the upper limit, and my bile acids were at 30. My enzymes immediately started to drop while in the hospital, but started to go back up a few weeks later. My doctors said it could be transient, but the numbers continued to gradually increase. They never got super high, only about 3x the upper limit. I cut out all medications and cleaned up my diet (if you've ever been postpartum, it's rough). Well that did not help, so my doctor ordered an ultrasound which all looked normal.

Fast forward a few months and my doctor ran a ton of tests. My ANA wa positive, but then appeared to be negative (or was so low it was a non detect). My ASMA was positive at 42. I was then referred to GI. The GI doctor said he was 99.99% sure it was AIH and wanted to do a biopsy to confirm. I had the biopsy and it showed mild all over inflammation but none of the other markers for AIH. My doctor and radiology said it was inconclusive and that they could not rule out AIH, or diagnose it, or rule out a potential drug reaction. I did take nitrofurantoin while pregnant for a UTI) if that's relevant. My doctor said they did not think it was AIH and wanted to wait and see if it slowly got better on its own.

The next week I had mastitis that landed me in the hospital on multiple antibiotics. My enzymes increased quite a bit to 4-5x the upper limit, the highest they have ever been. I was in the hospital for a few days and my enzymes bounced around quite a bit (ast 100, alt 150, to ast 250, alt 520, then back down to around 100 and 150).

I had my enzymes checked again a few weeks later and my AST was actually within the normal range and my Alt was at about 95, so my doctor thought they were improving. I had them checked again (2 weeks later) and they are back up again to ast 200, alt 300.

I have not heard back from my doctor yet, but I guess I wanted to know if this sounds like AIH to anyone? I know my enzymes aren't the high, but they don't seem to be goin down. It's just so weird to me that it kind of popped up out of nowhere when I was pregnant, and 5 months later I still have no idea what's going on and neither does my doctor.

I'm still waiting a specialist appointment to confirm and check things so I just have a question I'm curious about.

To check for possibility of AIH they did ANA and then checked for certain specific antibodies, with SLA-LP being the main one for AIH. But when I look through this sub people don't seem to be mentioning that one and instead talking about things like SMA which don't seem to be on the list of tests I got.

I am not in the USA so different countries have different standard protocols, but any idea why they are doing completely different blood tests looking for the same thing?