Could My Biologic Be Triggering Liver Issues? (Intricate Situation)
A 34-year-old male, standing 5'10" and weighing 199 lbs, has faced a longstanding battle with Crohn's disease since the age of six. At age 33, he received a diagnosis of Non-Hodgkins Lymphoma, specifically stage IV DLBCL, which had its origins in the small intestine and metastasized to the right kidney. Thankfully, as of July 2025, he is in a state of no evidence of disease (NED). His treatment protocol included a single round of RCVP chemotherapy, followed by five rounds of Pola-R-CHP and two rounds of Rituxan. Unfortunately, an emergency surgery was necessary on January 9, 2025, due to a small bowel perforation that led to peritonitis, necessitating the removal of 36 inches of the bowel. As a result of the surgical procedure, he now contends with a hernia. Recently, he experienced a focal necrosis in segment 6 of his liver, which, while not cancerous, remains inexplicable despite undergoing MRIs with and without contrast. He has recently begun treatment with Entyvio, having completed the loading doses and anticipating a full dose next week. Today's blood tests revealed an elevated alkaline phosphatase (ALP) level of 148 and an albumin level of 5.2. His triglycerides are alarmingly high (around 400), though cholesterol levels remain within normal ranges. On a brighter note, he avoids consuming alcohol. There's also a mild diagnosis of Non-Alcoholic Fatty Liver Disease (NAFLD), with a hepatic fat fraction measured at 8%. To provide a comprehensive overview of his liver's past challenges, he meticulously detailed his medical history, ensuring all aspects of his condition were highlighted. During a review of his case, his rheumatologist, impressed with the complexity, mentioned his ties to Columbia, humorously acknowledging the difficulty of the case. If you're in search of a stimulating challenge, look no further...
Answers (1)
9/13/2025, 9:10:35 PM
OpenHealth AI
It sounds like you're managing a complex health situation, and I commend you for your attention to detail and proactive approach. Your elevated alkaline phosphatase (ALP) and high triglycerides, alongside your history of Crohn's disease and recent treatments, certainly merit careful monitoring.
Main Points:
- Your current medications, including Entyvio, may affect liver health.
- Elevated ALP and triglycerides could potentially be related to liver issues, which may be further complicated by your past medical history.
- Your NAFLD diagnosis suggests the need for lifestyle adjustments.
Explanation:
Entyvio (vedolizumab) is a biologic medication used for Crohn's disease and inflammatory bowel disease, and while it is generally well-tolerated, all medications can have side effects. Elevated ALP levels can indicate bile duct issues or liver disease, while high triglycerides can contribute to NAFLD and may worsen liver function if not managed. Given your recent liver findings and surgery history, it’s crucial to evaluate potential connections between your treatment and liver health.
Actionable Next Steps:
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Dietary Adjustments: Focus on a heart-healthy diet low in saturated fats and sugars. Incorporate more fruits, vegetables, whole grains, and lean proteins to help lower triglycerides. Keeping your carbohydrate intake balanced, and considering a Mediterranean-style diet could be beneficial.
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Regular Monitoring: Continue to work closely with your healthcare provider to monitor liver enzymes and lipid levels. Regular blood tests every few months may be necessary to track changes.
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Hydration and Exercise: Aim for at least 150 minutes of moderate exercise weekly (like brisk walking) if able. Stay well-hydrated, which can help liver health and overall metabolic function.
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Limit Processed Foods: Reduce intake of processed foods, particularly those high in sugars and unhealthy fats, which can exacerbate NAFLD.
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Discuss with your Healthcare Team: Keep an open line of communication with your doctors about your liver health and any new symptoms you experience. It's important to report if you notice changes like fatigue, abdominal pain, or jaundice.
Please take these steps gradually and focus on what feels manageable. Your careful attention to these details will support your overall health as you navigate this intricate situation. Don’t hesitate to reach out if you have ongoing concerns or need clarification!
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