non-viral hepatitis-- possible causes?
January 30, 2015 11:41 AM   Subscribe

My sister/roommate travelled to Turkey for two weeks about a month ago and is now hospitalized for acute hepatitis. She became symptomatic about 28 days after the trip. She also recently took a prescribed antibiotics with known liver toxicity. Doctors said that the cause is not viral, and "most likely Turkey," and I don't know what that means.

We were very worried that it could be hepatitis A, in which case I need to get tested too. But her doctors are saying that it's definitely not viral, and it'll be a week before they can conclusively know what caused her hepatitis. Right now they are saying "It's most likely Turkey, but we don't know what it is."

They didn't give us a lot of their time. Do they mean maybe toxin exposure in Turkey? Do they mean food? If it's something that happened DURING the trip, how come it took so long before she got sick? Could it be one of the food/drinks/cups that she brought home as souvenir? If so then the source of the toxin is still in our apartment and we need to not be in contact. Why does the tests take so long? Could the antibiotics push her over the threshold? Can they be certain it's not Hep A, because I would really like to know how to protect myself.

Any ideas, recommendation for things to read, recommendations for search keywords, or explanations for non-viral, non-alcohol hepatitis, would be greatly appreciated.

*sister did not have a pre-existing liver condition; we both got Hep B and C vaccination but not A; she was in good health before all this.
posted by atetrachordofthree to Health & Fitness (15 answers total)
I think that hepatitis just means her liver is inflamed. Your liver can become inflamed for reasons other than a virus. Not to patronize but I'd read the Wikipedia page on hepatitis- it mentions non- viral versions. Also, talk to your doctor. Your doc can test you for hep A and give you the vaccine if you don't have hep A.
posted by kat518 at 11:47 AM on January 30, 2015 [2 favorites]

To protect yourself from hep A, all you have to do is wash your hands. It is fecal-oral transmission.
posted by treehorn+bunny at 11:56 AM on January 30, 2015 [1 favorite]

I did a quick skim of WebMD and didn't see any causes of non-viral hepatitis that jumped out at me as being obviously connected to a trip to Turkey. I don't know what the doctors mean by "most likely Turkey," since non-viral liver inflammation isn't a common risk for tourists in my experience.

But as kat518 says, hepatitis is a catch-all term for liver inflammation, so who knows?

I don't see how a person could contract non-viral hepatitis from food, but I'm not a doctor. A quick google of toxins that cause hepatitis mentions alcohol, medications, and industrial chemicals. Are her doctors concerned that she ate something in Turkey that was contaminated by industrial chemicals?

If you're concerned about something she brought home from her trip, just don't eat/drink/use whatever it is, and you should be fine.
posted by Sara C. at 12:01 PM on January 30, 2015

The classic thing you'd expect if it was connected to foreign travel would be hep-A or maybe hep-E, either of which can be caused by fecal contamination of food. (Incidentally the average incubation period for hep-A is about 28 days but it sounds like they ruled it out already.)

If they're saying that viral hepatitis is for sure ruled out than the delay is probably because they're just using hepatitis in its most general sense to mean liver inflammation, which can have a lot of causes. Could be a drug reaction, could be alcohol-related (especially if she combined tylenol and alcohol), could be some autoimmune thing.

In terms of diagnostic testing it's hard to know what the delay could be without knowing the differential her doctors are working through, but besides blood tests (most liver function blood tests should come back within a day, assuming an in-house lab runs them right away) it's possible they may use various types of imaging or even a liver biopsy - did they say anything about that? Scheduling those procedures can take time.
posted by Wretch729 at 12:04 PM on January 30, 2015

Hepatitis A has a pretty long incubation period and can show up 1-2 months after exposure. There are some other fairly common causes of hepatitis like nonalcoholic fatty liver (steatohepatitis) and mononucleosis. Very unlikely to be a toxin exposure, that is rare.

Liver function tests come back fast but things like hepatitis panels and mono testing take longer. Doubt they took a liver biopsy, OP would have mentioned it and that would be unusual.

By the way, it's easy to get hep A vaccination, I suggest doing it before you travel next time. You may have misunderstood, there is no vaccine for hep C- I wish there was!
posted by treehorn+bunny at 12:09 PM on January 30, 2015 [2 favorites]

Yep, no such thing as a hep c vaccine, yet. Could you have received hepatitis A and B vaccinations? I would review your records, since that could be clarifying.
posted by reren at 12:12 PM on January 30, 2015

I got Hepatitus A as a kid. We were staying in a tiny town in Mexico that did not have electricity or sewage. We went swimming in the ocean every morning, and it turned out mornings where when the town dumped it's garbage in the ocean. Even though we were some ways away from the town and never saw any thing suspicious floating by, that was enough to do it.

Try not to freak out about this. Hepatitis A is not as serious as the others if treated properly. Your sister will be well soon.
posted by WalkerWestridge at 1:02 PM on January 30, 2015

Are you sure you got hep C vaccines? I think those are still in human trials. A and B vaccines have been around a long time, though and are commonly offered. Anyway, I son's think it matters bc as others have said, it sounds like the docs are using the word to generally describe an inflamed liver.
posted by atomicstone at 1:43 PM on January 30, 2015

A similar thing happened in my family. My parents went on a trip to Mexico, and my mom had been taking an antibiotic before the trip. She had a bad reaction to it, and they initially assumed she had contracted viral hepatitis in Mexico. However, the doctors eventually determined that it was the antibiotic.

So, it could definitely be a drug reaction. My mom is fine, now, so hang in there and try not to worry too much.
posted by incountrysleep at 1:45 PM on January 30, 2015

"Most likely Turkey" is their time-strapped way of saying, "it was probably caused by something having to do with her trip to Turkey." It's not a diagnosis, just their way of brushing it off and giving an answer, any answer.

They know it's not viral, so it's not one of the Hep-* illnesses. All of the lab/pathology results will be back in a week, and then they'll know whether it's another type of infection or not, and how it's affecting her liver in detail - and then they can treat it, if possible. Or do more tests, if the results seem to warrant it.

Basically, they're saying, "We have no idea yet, except that the viral tests came back negative. It's probably related to her trip to Turkey, but that's just a guess. In a week we'll have more results and can rule out more things."

By "if possible", I mean, "if the problem won't resolve on its own," not "if there's no cure and she'll have this forever." The liver is very resilient.
posted by WasabiFlux at 1:45 PM on January 30, 2015

thanks guys for all the input so far!

I just brought my sister home, and got to talk to her doctor for like 30 seconds, because on her report it still says HAV is a possibility. The doctor said that Hep A is still on the differential, but their only medical recommendation at this point is that she doesn't prepare food for me, and that we both practice good hand hygiene. Earlier they told my sister that they think it's most likely caused by her ingesting fecal contaminated food, but they think I probably won't get it.

So now I am super confused. They said a week from now they would know for sure (ok but isn't a viral test way faster than that?! and have they not bothered to test for HAV?), but that's cutting really close to my departure date (travelling to the US) and also I volunteer at a geriatric centre so I really kind of would prefer not having to wait for a week to know.

Could anyone advice if I should go ahead and get tested and either get a vaccination or an imunoglobulin shot?

As for the labs- they did an ultrasound, but no biopsy. I think I meant we both have HepB vaccination as children...sorry, got confused. My point was that pretty sure we don't have Hep A vaccination.
posted by atetrachordofthree at 2:08 PM on January 30, 2015

Also, to clarify--

All things they've said sounded to me like Hep A actually, but they wouldn't say if it is Hep A or not, and were super vague about it. They also told my sister verbally "definitely not viral" and then wrote on report that HAV, HBV, HCV were all still to be tested in her follow-up. I get that doctors are busy but this is super self-contradictory and confusing to me. They were very impatient when I insisted on talking to them to ask.
posted by atetrachordofthree at 2:11 PM on January 30, 2015

They could be running several different types of tests. An antibody test is when they look for antibodies against Hepatitis. However, it takes the body some time to actually produce antibodies, so there could be a window period where the infected person might get a false negative. Maybe they ran the antibody test and got a negative, but still want to double check and make sure she doesn't have Hepatitis? In that case, they might be running a test that looks for the actual virus in the blood and not the antibodies.
posted by Lingasol at 4:17 PM on January 30, 2015

First off: I'm so sorry for your sister, liver problems are no joke.

I had what turned out to be Hep E a few years back. It was awful and terrifying. The diagnosis process was:

Fall ill on a business trip, think it's flu, realize after a time it can't be, go to doc in business trip town. Doc is totally unsure, takes bloods for labs, sends me on my way.

Phone call later that night saying, your liver enzyme levels are high, don't take painkillers and don't drink. See a doc right away when you get home.

See doc right away, he freaks at enzyme levels. Orders Hep A,B,C tests, all negative.

Sends me for liver ultrasound, no tumors.

Sends me to hepatologist, further viral testing, Hep E diagnosis.

I'd say it took about a week from seeing the first doc to getting the diagnosis for sure.

Still not totally sure how I got it--my best guess is a sandwich from a somewhat sketchy deli in Boston.
posted by Sublimity at 5:40 PM on January 30, 2015

I had an encounter with hepatitis-like symptoms a little over a year ago. I had just flown internationally from the US to Australia and felt flu-ey for a couple of days following. When I realised I was feeling worse, not better, I visited my GP. She did some routine blood tests and then called me back later that evening to say "go to the ER, you have hepatitis." I was admitted and they ran tests that night and all the next day, including bloodwork, X-rays, ultrasound, and a CT. Everything came back negative, though still my liver enzymes were off-the-charts high.

The specialists were all scratching their heads, since I tested negative for every viral form of hepatitis, and we could not identify any possible drug- or poison-related cause. By the second day in the hospital, the numbers started to come down. I was discharged at the end of the third day, and the number improved dramatically over the next week, and took about a month to get completely back to normal.

The specialist thought it might be a case of ischemic hepatitis, but she couldn't be sure, and this was just by process of elimination of all other likely causes. In the end, I was discharged with a diagnosis of "deranged liver", but they admitted that they really had no idea what had caused the episode. I'm sharing all this because it's quite possible that your sister's hepatitis is not viral at all. And it's also quite possible that she might not learn the cause. I never did.
posted by amusebuche at 9:02 PM on January 31, 2015

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