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Immunoglobulin-complexed aspartate aminotransferase

S Matama¹, H Ito, S Tanabe

¹Department of Gastroenterology, Kitasato University East Hospital, Sagamihara, Japan.

Internal Medicine (Tokyo, Japan)

|February 1, 1993

Summary

A persistent elevation in aspartate aminotransferase (AST) in a healthy teen was linked to rare IgG-complexed AST macromolecular complexes. Awareness of this benign condition prevents unnecessary medical interventions.

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Area of Science:

Clinical Chemistry
Immunology
Hepatology

Background:

Elevated liver enzymes often indicate hepatic disease, necessitating diagnostic workup.
Persistent elevation of aspartate aminotransferase (AST) requires careful evaluation to determine the underlying cause.

Observation:

A 17-year-old female presented with persistently high serum AST levels (up to 259 IU/l) over three years, with normal alanine aminotransferase (ALT).
The patient was asymptomatic and otherwise healthy, suggesting a non-pathological cause for the elevated AST.

Findings:

Advanced immunoelectrosyneresis and immunoprecipitation assays identified atypical AST forming macromolecular complexes with immunoglobulin G (IgG) and kappa/lambda light chains.
This case represents the 26th reported instance of IgG-complexed AST, a rare phenomenon characterized by macro-enzyme formation.

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Implications:

Recognition of IgG-complexed AST syndrome is crucial for clinicians to avoid misdiagnosis and unnecessary investigations or treatments.
Understanding this benign cause of elevated AST can prevent patient anxiety and reduce healthcare costs associated with extensive workups for liver disease.