Asymptomatic Elevation Research Articles

Rhabdomyolysis as a rare but fatal complication of bariatric surgery: A case report.

Rhabdomyolysis after bariatric surgery is a quite rare occurrence with low recognition. Due to the breakdown of the striated muscle fibers, creatine kinase and myoglobin are released into the systemic circulation with variable effects on the renal filtration functions. Herein we present the case of a patient who developed rhabdomyolysis following revision bariatric surgery. A 34-year-old male patient was admitted for bariatric surgery. He had undergone a gastric band surgery approximately 6 years ago, with weight regain starting 1 year postoperatively gradually reaching the previous weight level. Consequently, the gastric band was removed with open surgery 3 years ago. The patient had a body mass index of 69 kg/m2 and an incisional hernia due to the previous surgery. Although initially, laparoscopic sleeve gastrectomy was planned, a switch to open surgery was made due to the presence of diffuse intra-abdominal adhesions and a giant incisional hernia precluding a laparoscopic intervention. The total duration of surgery was 420 min. Postoperative laboratory work-up showed elevated blood creatine kinase levels (25837 U/L). Upon the failure of fluid replacement and diuretics, hemodialysis was initiated on postoperative day 1. Despite daily sessions of hemodialysis, the patient's acidosis did not improve; his general status worsened, and he died on postoperative day 14. Rhabdomyolysis is a severe and potentially life-threatening complication of bariatric surgery. Its severity may vary from asymptomatic elevation in creatine kinase levels to death. Postoperative creatine kinase levels should be routinely monitored in high-risk patients as a practical and inexpensive laboratory modality for early diagnosis.

Conservative Management of Acute Kidney Injury

Acute kidney injury (AKI) is one of the most common complications occurring among intensive care unit (ICU) patients and is independently associated with a higher risk of mortality. In critically ill patients, AKI presentation is heterogeneous, varying from asymptomatic elevations in serum creatinine to the need for dialysis in the context of multiorgan failure. Within this range of clinical presentation, the kidney is often overlooked because improving and maintaining cardiac performance are the focus. In addition, aggressive fluid resuscitation may impose significant demands on the kidney wherein the normal excretory capacity may be overwhelmed. ICU patients often have underlying comorbidities, including chronic kidney disease and heart failure, which further limit the range of renal capacity. Drug and nutritional administration contribute to the demand for fluid removal to maintain fluid balance. The dissimilarities of the critical care environment and the extra demand kidney capacity highlight the need for different strategies for management and treatment of AKI in the critically ill patients. We focus this review on the general and nondialytic therapy of AKI. This reference contains 5 figures, 3 tables and 90 references Key words: Acute kidney injury, fluid resuscitation, loop diuretics, vasoactive agents, fluid overload, hiperkalemia, and metabolic acidosis.

Severe Rhabdomyolysis as an Unusual Presentation of Primary Human Immunodeficiency Virus Infection

Rhabdomyolysis is characterized by muscle necrosis and leakage of toxic intracellular contents into the circulatory system. It is most commonly caused by trauma, physical exertion, drugs, toxins, and a variety of infections; only rarely is it associated with acute human immunodeficiency virus (HIV) infection alone. The severity of illness ranges from asymptomatic elevations in serum muscle enzymes to life-threatening electrolyte imbalances and acute kidney injury. High HIV viral load is associated with higher muscle breakdown that increases the incidence of severe acute kidney injury and sometimes the need for renal replacement therapy. The introduction of highly active antiretroviral therapy (HAART) revolutionized the treatment of HIV infection and increased the life expectancy of such patients by suppressing viral replication. Myopathy is one of the neuromuscular manifestations of HIV. It can occur either as a result of a complication of HIV itself or as a result of medicines used to control HIV. Muscle involvement of HIV infection ranges from asymptomatic muscle enzyme elevation to severe, HIV-associated polymyositis or pyomyositis. Here we report a case of acute retroviral syndrome presenting as severe non-traumatic rhabdomyolysis.

Meganuclease targeting of PCSK9 in macaque liver leads to stable reduction in serum cholesterol.

Clinical translation of in vivo genome editing to treat human genetic diseases requires thorough preclinical studies in relevant animal models to assess safety and efficacy. A promising approach to treat hypercholesterolemia is inactivating the secreted protein PCSK9, an antagonist of the LDL receptor. Here we show that single infusions in six non-human primates of adeno-associated virus vector expressing an engineered meganuclease targeting PCSK9 results in dose-dependent disruption of PCSK9 in liver, as well as a stable reduction in circulating PCSK9 and serum cholesterol. Animals experienced transient, asymptomatic elevations of serum transaminases owing to the formation of T cells against the transgene product. Vector DNA and meganuclease expression declined rapidly, leaving stable populations of genome-edited hepatocytes. A second-generation PCSK9-specific meganuclease showed reduced off-target cleavage. These studies demonstrate efficient, physiologically relevant in vivo editing in non-human primates, and highlight safety considerations for clinical translation.

Clinical Profile of Diabetic Patients with Liver Dysfunction

The spectrum of clinical disease in fatty liver with steatohepatitis varies from the asymptomatic elevation of liver enzymes to severe liver disease with fibrosis and nodular regeneration. Patients with nonalcoholic steatohepatitis can develop progressive liver disease and complications to the point that they may need liver transplantation.Nonalcoholic steatohepatitis should be considered as a cause for chronically elevated liver enzymes in asymptomatic diabetic patients particularly if they are obese and have hyperlipidemia.This study was carried out among 100 diabetic patients diagnosed to be with hepatic dysfunction attending tertiary care hospital during the study period. Maximum number of patients had diabetic nephropathy (17%), followed by diabetic retinopathy (15%), peripheral neuropathy (11%) and peripheral vascular disease (4%). Neuropathy, Nephropathy, PVD and Retinopathy were present in patients who had diabetes for more than 10 years.

Cardiotoxicity of Immunotherapy: Incidence, Diagnosis, and Management.

This review describes cardiotoxicity associated with adoptive T cell therapy and immune checkpoint blockade. Cardiotoxicity is a rare but potentially fatal complication associated with novel immunotherapies. Both affinity-enhanced and chimeric antigen receptor T cells have been reported to cause hypotension, arrhythmia, and left ventricular dysfunction, typically in the setting of cytokine release syndrome. Immune checkpoint inhibitors are generally well-tolerated but have the potential to cause myocarditis, with clinical presentations ranging from asymptomatic cardiac biomarker elevation to heart failure, arrhythmia, and cardiogenic shock. Electrocardiography, cardiac biomarker measurement, and cardiac imaging are key components of the diagnostic evaluation. For suspected myocarditis, endomyocardial biopsy is recommended if the diagnosis remains unclear after initial testing. The incidence of immunotherapy-associated cardiotoxicity is likely underestimated and may increase as adoptive T cell therapy and immune checkpoint inhibitors are used in larger populations and for longer durations of therapy. Baseline and serial cardiac evaluation is recommended to facilitate early identification and treatment of cardiotoxicity.

PP-59 - An Unusual Case of Asymptomatic Diffuse Alveolar Hemorrhage Related to Amiodarone Induced INR Elevation

Abstract: Pulmonary adverse effects of amiodarone is an important cause of morbidity. Despite pulmonary toxicity occurs as pneumonitis, rarely, it may also occur as diffuse alveolar hemorrhage. Another important amiodarone-induced adverse effect is hepatotoxicity. Hepatotoxicity mostly presents as asymptomatic elevation of liver enzymes. To the best of our knowledge, in amiodarone-induced hepatotoxicity AST, ALT elevation is well known, however, there is no clear data about high International normalized ratio (INR) level in this condition. In this case report, a patient was presented under management of chronic low-dose amiodarone who admitted to emergency department for hematoma on his tongue. During the assessment for bleeding diathesis, INR was found to be 8.59. All other causes were excluded for high INR level in this case and amiodarone was related to high INR level. Since there were diffuse infiltrations on chest X-ray, the patient underwent thorax tomography. Asymptomatic diffuse alveolar hemorrhage secondary to INR elevation was considered. This patient is the first case who had amiodarone-induced INR elevation, and as a consequence, developed asymptomatic diffuse alveolar hemorrhage.

Autoimmune necrotising myopathy and HMGCR antibodies

Statins lower serum cholesterol concentrations by inhibiting the enzyme 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR). Muscle side effects are relatively common and include asymptomatic elevation of serum creatine kinase (CK), myalgia, proximal...

Conservative Management of Acute Kidney Injury

Acute kidney injury (AKI) is one of the most common complications occurring among intensive care unit (ICU) patients and is independently associated with a higher risk of mortality. In critically ill patients, AKI presentation is heterogeneous, varying from asymptomatic elevations in serum creatinine to the need for dialysis in the context of multiorgan failure. Within this range of clinical presentation, the kidney is often overlooked because improving and maintaining cardiac performance are the focus. In addition, aggressive fluid resuscitation may impose significant demands on the kidney wherein the normal excretory capacity may be overwhelmed. ICU patients often have underlying comorbidities, including chronic kidney disease and heart failure, which further limit the range of renal capacity. Drug and nutritional administration contribute to the demand for fluid removal to maintain fluid balance. The dissimilarities of the critical care environment and the extra demand kidney capacity highlight the need for different strategies for management and treatment of AKI in the critically ill patients. We focus this review on the general and nondialytic therapy of AKI. This reference contains 5 figures, 3 tables and 90 references Key words: Acute kidney injury, fluid resuscitation, loop diuretics, vasoactive agents, fluid overload, hiperkalemia, and metabolic acidosis.

Is combination treatment with a statin + a fibrate dangerous? Two case reports

Background Statins are widely used for reducing serum low-density lipoprotein cholesterol (LDL). Fenofibrate, a fibric acid derivative, is used to treat hypertriglyceridemia. Statins are well known to be associated with muscle disorders ranging from simple asymptomatic elevations of creatine phosphokinase (CPK) to rhabdomyolysis. Fibrates are frequently used together with statins when there are significant triglyceride levels along with high LDL levels. The incidence of myopathy associated with statin and fibrate combination is ≈ 0.5–2.5%. We report two cases of significant myopathy apparently precipitated by fenofibrates in patients already taking low doses of a statin.

An Unexpected Outcome Following Radiofrequency Ablation of a Malignant Biliary Stricture

A 60-year-old woman with extrahepatic cholangiocarcinoma and recurrent malignant biliary strictures status-post placement of two overlapping distal bile duct uncovered self-expandable metal stent (SEMS) presented with fevers, pruritis, and abdominal pain. Laboratory findings revealed a total bilirubin of 4.2 mg/dL and alkaline phosphatase of 920 U/L. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated stenosis in the common bile duct (CBD) due to tumor/tissue ingrowth through prior SEMS (Image A). Tumor/tissue destruction was performed with radiofrequency ablation (RFA) using the HabibTM EndoHPB Probe. Intrabiliary RFA was applied to the stenosis (ERBE generator, bipolar soft coag 10 watts) for 90 seconds. Two sequential applications were applied to the length of the stricture. Immediately following RFA, the periampullary mucosa was noted to be pale (Images B, C). A double pigtail plastic biliary stent was placed in the left hepatic duct. Overnight she developed epigastric pain with a lipase of 923 U/L. Her mild acute pancreatitis was managed conservatively and she was discharged on post-ERCP day 4; plastic stents were removed after two months. She returned eight weeks later with recurrent cholangitis. ERCP revealed an intra-stent biliary stricture in the mid-CBD. Two intraductal RFA applications were performed without mucosal changes, and a covered SEMS was placed. She later developed epigastric pain with elevated lipase; again with documented evidence of post-RFA acute pancreatitis. She was successfully treated conservatively. In the absence of other identifiable causes, our hypothesis is that acute pancreatitis was caused by thermal burn injury from RFA, representing the first confirmed case due to its recurrent nature. In malignant biliary obstruction with stent placement, RFA causes coagulative necrosis of tumor tissue to prevent tumor ingrowth and epithelial hyperplasia, improving biliary stent patency. A literature review of RFA through SEMS for biliary tissue/tumor ingrowth reveals no reported cases of thermal burn injury causing acute pancreatitis. In two single center studies, one patient developed mild pancreatitis after RFA but without endoscopic evidence of thermal burn injury; another patient developed asymptomatic amylase elevation. As RFA through SEMS becomes more widely used, thermal burn injury-induced acute pancreatitis represents a potential adverse event, and represents another specific etiology for acute pancreatitis.Figure: Tumor/tissue ingrowth of SEMS.Figure: Pale peri-ampullary mucosa.Figure: Closer view of pale peri-ampullary mucosa.

PIN111 - Hepatoprotective Effect Of Herbal Remedy With Anti-Tuberculosis Treatment

S.D. Asfendiyarov Kazakh National Medical University, Almaty, Republic of Kazakhstan Introduction: Tuberculosis is one of the leading causes of death among infectious diseases in developing and undeveloped countries. According to the WHO Western Pacific Region fact sheet on tuberculosis. Hepatotoxicity, a common adverse effect of anti-tuberculosis drugs, varies from asymptomatic elevation of liver enzymes to fulminant hepatic failure. The study protocol was approved by the Ethics Committee on Human Rights related research. From the total of 55 patients, there were no significant differences in the distribution of the demographic characteristics. Antituberculosis drug-induced hepatotoxicity (ATDH) was seen in 17 (18.8%) out of 90 patients. Average age of the ATDH case was 35.65 ± 10.8 (CL 95% 18-81) sex ratio was 22.5% in men, 16% in women. During pre and post-treatment liver biochemical analyzes criteria such as AST, ALT, total bilirubin, and protein were not statistical significant between groups which are treated with Silymarin. However, in control group had a statistically significant difference total bilirubin and protein between pre and post-treatment liver biochemical analyzes criteria such as AST, ALT. Anti-tuberculosis drugs are used in combination, except in latent tuberculosis or chemoprophylaxis. The rate of hepatotoxicity is much higher in developing countries like India (8%–30%) compared to that in advanced countries. Therefore, we selected patients who have tuberculosis to study the hepatotoxic effect of antituberculosis drugs and hepatoprotective action of Silymarin. The serum ALT, AST of the control group (group I) and the Silymarin group (group II, III) show significant difference when compared with baseline values. This showed that Silymarin has significant desired actions. Conclusions Silymarin reduced the incidence of antiTB-DILI. The benefit of Silymarin may be explained from superoxide dismutase restoration. Larger clinical trials are required to confirm the result of our small study. 1. WHO.Global tuberculos report 2014

Allopurinol-Induced Granulomatous Hepatitis

Introduction: Liver enzyme elevation is a common reason for referral to the Gastroenterologist. Drugs are one of the most common reasons for asymptomatic elevation of liver enzymes. We present here a case of granulomatous hepatitis (GH) secondary to long-term use of allopurinol.Figure: A low power showing the expanded portal tracts.Figure: a higher power showing the mixed nature of the inflammation (including lymphocytes, plasma cells, neutrophils and eosinophils).Case: An 83-year old male with a history of chronic gout and hypertension was evaluated for elevation of liver enzymes. He denies any complaints of abdominal pain, nausea, fever, chills, weight loss, night sweats or yellowness of skin. He denies any use of herbal medications. He was a heavy drinker in the past but now cut down his drinking to 2 beers a week. He was on Losartan, statins and allopurinol for years. No new medications reported. Physical examination was unremarkable. Labs showed AST 101 U/L, ALT 81 U/L, and ALP 645 U/L. Hepatitis panel, ANA and anti-smooth muscle antibody unremarkable. Ultrasound of the abdomen showed coarse liver texture concerning for parenchymal disease. Liver biopsy was done which showed mixed GH (Figure 1, 2 and 3). Given negative autoimmune and viral serologies, allopurinol-induced GH was suspected. His liver chemistries improved after stopping the allopurinol (Table 1).Figure: Well-formed epithelioid granuloma seen.Discussion: Hepatic Granulomas are associated with many systemic conditions including systemic infections, malignancy and autoimmune disorders. Many drugs have been associated with GH including allopurinol, diltiazem, amiodarone, and penicillin. The clinical manifestation of GH is variable. Fever is common in infectious causes like AIDS. Weight loss and night sweats are also common. Similar to our patient, some present with asymptomatic elevation of liver enzymes. Removal of the offending drug is the beneficial treatment. Corticosteroids are not generally recommended for drug-induced liver injury and the use is limited to severe cholestatic jaundice with no improvement after removal of drug or concomitant extrahepatic manifestation secondary to hypersensitivity to the drug. Serial follow-up of liver chemistries should be done to evaluate for improvement. Patients with signs and symptoms of hepatic failure should be referred to transplant center. Bilirubin levels > 2 times along with ALT > 3 times the upper normal limit following initiation of a drug is the indicator of a poor outcome and should be evaluated by a hepatologist. Prevention is the key and can be done by patient education, appropriate dosing and checking liver chemistries if liver dysfunction is suspected.

Value of HCV Core Antigen Testing in Detection of HCV Antibody Negative HCV Infection in Patients with Asymptomatic Elevation of Liver Transaminases of Unknown Etiology

Value of HCV Core Antigen Testing in Detection of HCV Antibody Negative HCV Infection in Patients with Asymptomatic Elevation of Liver Transaminases of Unknown Etiology

Application and Indication of Carcinoembryonic Antigen Triggered 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Scanning in the Detection of Relapse of Colorectal Cancer Patients After Curative Therapy

This study aimed to explore the characteristics of patients with colorectal cancer (CRC) following curative therapy that may benefit from fluorine-18-2-uoro-2-deoxy-D-glucose positron emission tomography/computed tomography (F-FDG PET/CT) scanning, evaluate the application of carcinoembryonic antigen (CEA)-triggered F-FDG PET/CT scanning, and provide referential indicators. This retrospective study included 56 CRC patients who received a PET/CT scan as a primary examination because of rising CEA levels after curative therapy and who had not received any other radiological examinations previously. The rate of recurrence or metastasis was 75.0% by PET/CT scan but was 69.6% with follow-up treatment. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 94.9%, 70.6%, 87.5%, 88.1%, and 85.7%, respectively. TNM (tumor, node, metastasis) stage, body mass index, and CEA level were significant prognostic factors. Positron emission tomography/CT can be selectively applied as a primary examination in CRC patients with asymptomatic elevation of CEA. High CEA levels, increased body mass index, and advanced TNM staging are risk factors for relapse.

Allopurinol-Induced Granulomatous Hepatitis: A Case Report and Review of Literature

Liver enzyme elevation is a common reason for referral to a gastroenterologist. Drugs are one of the most common reasons for asymptomatic elevation of liver enzymes. We present here a case of granulomatous hepatitis (GH) secondary to long-term use of allopurinol. An 83-year-old male with a history of chronic gout and hypertension was evaluated for elevation of liver enzymes. He denies any complaints of abdominal pain, nausea, fever, chills, weight loss, night sweats, or yellowness of skin. He denies any use of herbal medications. He was on losartan and allopurinol for years. No new medications reported. Physical examination was unremarkable. Labs showed aspartate transaminase 101 U/L, alanine transaminase 81 U/L, and alkaline phosphatase 645 U/L. Ultrasound of the abdomen showed coarse liver texture. Liver biopsy was done that showed mixed GH. Given negative autoimmune and viral serologies, allopurinol-induced GH was suspected. Allopurinol was held, and repeat liver enzymes were checked in 3 months, which showed improvement in transaminase and alkaline phosphatase levels. This case highlights the importance of reviewing medications carefully when evaluating a patient with liver enzymes elevation, as stopping the offending drug can normalize the abnormalities in liver chemistries and can prevent subsequent expensive testing.

Inotuzumab ozogamicin in pediatric patients with relapsed/refractory acute lymphoblastic leukemia (R/R ALL).

10512 Background: Inotuzumab ozogamicin (InO), a CD22-targeting antibody linked to calicheamicin demonstrated exceptional activity in R/R ALL in adults. InO has been available to pediatric patients with R/R ALL via a compassionate access program. Methods: Participating international pediatric oncology centers received IRB approval to submit retrospective demographic, outcome and toxicity data on pediatric patients who received at least one dose of InO. Results: Thirty-four patients, age 2.3-21.4 yrs (median 11.7) received 1-4 cycles (3 weekly doses) of InO. Patients were heavily pretreated in 1st-5threlapse; 28 were refractory to their preceding regimen. Thirteen patients had prior hematopoietic stem cell transplant (HSCT), 27 received prior CD19 and 8 prior CD22-directed therapy. Pre-InO disease was M3 ( > 25% blasts) in 26 patients, M2 (5-25%) in 3, and MRD only in 5 (1 with extramedullary disease). Of 29 patients with M2/M3 disease at baseline, 18 (62%) achieved a complete remission (CR), 13 of whom were MRD negative. Post-InO, 15 patients proceeded to HSCT and 5 to CAR T-cell therapy. Alterations in CD22 expression at subsequent relapse were noted in two patients with available blasts samples. No deaths were attributed to InO during therapy. The incidence of grade 3/4 infections was 38% and were of the expected types. Grade 1-4 hepatic toxicity was noted in 11/34 (32%) patients, primarily asymptomatic elevations in transaminases/bilirubin. There was no sinusoidal obstruction syndrome (SOS) during InO therapy but 8/15 patients who received HSCT post-InO developed SOS. One patient died from SOS, but the others recovered. The incidence of SOS was higher in patients who had undergone prior HSCT (6/8) versus no prior HSCT (2/7). SIRS (1), neurotoxicity (2) and hemorrhage (3) were infrequent. Three patients had musculoskeletal pain associated with edema. Conclusions: Single agent InO had a CR rate of 62% in heavily pretreated pediatric patients. Toxicities were similar to adults with hepatic and infectious toxicity being the most common. Overall InO was well tolerated, but the incidence of SOS was high in patients who underwent HSCT post-InO, particularly in those who had undergone a prior HSCT.

Biliary and pancreatic complications of molecular targeted therapies in cancer imaging.

The purpose of this review is to familiarize radiologists with the different imaging manifestations of biliary and pancreatic toxicity of molecular targeted therapies. The advent of moleculartargeted therapies for cancer treatment has prompted radiologists to be familiar with these new molecules, their patterns of response, and their class-specific toxicities. While liver and bowel toxicities have been extensively reported in literature, less is known about the pathogenesis and imaging of toxicity involving the pancreatobiliary system. Biliary and pancreatic toxicity of moleculartargeted therapies present with variable manifestations and varying degrees of severity, from asymptomatic liver function tests elevation to acute pancreatitis or cholecystitis. Management of these conditions depends on the clinical scenario and the severity of the findings. In this article, we will (1) present the various classes of moleculartargeted therapies most commonly associated with biliary and pancreatic toxicity; (2) illustrate imaging findings of drug-associated biliary and pancreatic injuries and their possible differential diagnosis; and (3) provide a guide for management of these conditions.

Metabolites as biomarkers of adverse reactions following vaccination: A pilot study using nuclear magnetic resonance metabolomics

An Adverse Event Following Immunization (AEFI) is an adverse reaction to a vaccination that goes above and beyond the usual side effects associated with vaccinations. One serious AEFI related to the smallpox vaccine is myopericarditis. Metabolomics involves the study of the low molecular weight metabolite profile of cells, tissues, and biological fluids, and provides a functional readout of the phenotype. Metabolomics may help identify a particular metabolic signature in serum of subjects who are predisposed to developing AEFIs. The goal of this study was to identify metabolic markers that may predict the development of adverse events following smallpox vaccination. Serum samples were collected from military personnel prior to and following receipt of smallpox vaccine. The study population included five subjects who were clinically diagnosed with myopericarditis, 30 subjects with asymptomatic elevation of troponins, and 31 subjects with systemic symptoms following immunization, and 34 subjects with no AEFI, serving as controls. Two-hundred pre- and post-smallpox vaccination sera were analyzed by untargeted metabolomics using 1H nuclear magnetic resonance (NMR) spectroscopy. Baseline (pre-) and post-vaccination samples from individuals who experienced clinically verified myocarditis or asymptomatic elevation of troponins were more metabolically distinguishable pre- and post-vaccination compared to individuals who only experienced systemic symptoms, or controls. Metabolomics profiles pre- and post-receipt of vaccine differed substantially when an AEFI resulted. This study is the first to describe pre- and post-vaccination metabolic profiles of subjects who developed an adverse event following immunization. The study demonstrates the promise of metabolites for determining mechanisms associated with subjects who develop AEFI and the potential to develop predictive biomarkers.

Pattern and Significance of Asymptomatic Elevation of Liver Enzymes in Mycoplasma Pneumonia in Children.

Mycoplasma infection is on the rise in recent times. It usually infects any system, including liver. This study aims to show the significance of elevated liver enzymes in mycoplasma pneumonia and to have a look at future prospects. This is a single-center retrospective study involving 105 children serologically positive for mycoplasma IgM and IgG antibodies and 50 with community-acquired pneumonia caused by organisms other than mycoplasma and Epstein-Barr virus from June 2015 to June 2016 and all without prior liver disease. The patients were followed after 10 days (7-14 days). The liver enzymes were significantly elevated in Mycoplasma pneumoniae infection. The mean levels of alanine transaminase and aspartate transaminase were 39.3 and 32.5 IU/L, respectively. There was a seasonal variation during the months of September and February. Liver involvement in mycoplasma pneumonia is mostly a benign condition and asymptomatic. It is insisted that children with continued elevation should be followed conservatively to avoid unnecessary diagnostic procedures in the future.