Elevated AST, ALT and LDH

Question

I was hospitalized a few days last week with an as yet undiagnosed severely painful gastrointestinal disorder. I was told that my liver enzymes were elevated, but I don't have those numbers.

A followup liver panel this week revealed AST-116, ALT-83 and LDH-1164. I am asplenic, have a normal lipid range, and VL<50 and CD4-2150, HIV+ for 12 years. I have yet to hear from my ID doctor, but my PCM has ordered an ultrasound and CAT scan. I've been innoculated for Hep A&B.

Given my otherwise great numbers, am I currently at risk for lymphoma or, if not that, what other issues should I be concerned with.

Thanks

Answer

Lymphoma, both non-Hogkins and Hodgkins lymphoma should be included in the differential diagnosis. In general NHL occurs with much lower CD4 cell counts, but can occur with relatively normal counts. A markedly elevated LDH such as yours, is a nonspecific finding indicating some inflammatory/infectious process and an imaging study is clearly indicated.