{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T12:47:06Z","timestamp":1792586826040,"version":"4.5.0"},"reference-count":11,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"vor","delay-in-days":293,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Gastrointestinal Medicine"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In clinical hepatology practice, pretreatment liver enzyme screening plays a key role in making management decisions, such as initiation of antituberculosis therapy or surveillance of chronic hepatitis B. Unrecognized extrahepatic sources of aminotransferase elevations can lead to misdiagnosis, inappropriate treatment alteration, and unnecessary invasive or costly investigations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>We present two cases of active young males who were undergoing liver biochemical testing for therapeutic decision\u2010making for other underlying illnesses. Patient one was undergoing baseline liver enzyme testing prior to first\u2010line antituberculosis treatment initiation while patient two was undergoing surveillance for e\u2010antigen\u2010negative hepatitis B infection. Both patients had asymptomatic aminotransferase elevations mimicking acute hepatocellular injury. There was a marked and disproportionate elevation of aspartate aminotransferase (AST) relative to alanine aminotransferase (ALT), in the setting of otherwise normal cholestatic and synthetic parameters. Targeted history revealed heavy resistance weight training prior to testing. Measurement of serum creatine kinase (CK) confirmed exercise\u2010induced muscle injury, demonstrating elevated CK concentrations that paralleled the AST trajectory. Cessation of strenuous training led to rapid normalization of aminotransferases and a decline in CK levels, without interruption of tuberculosis management or unwarranted antiviral initiation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Clinically silent exertional muscle injury is an underappreciated mimicker of acute liver injury. In patients presenting with isolated or disproportionate AST elevation, confirming a myogenic enzyme source via CK quantification can prevent misdiagnosis, eliminate unnecessary liver\u2010directed workup, and avoid inappropriate modification or initiation of essential pharmacotherapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/crgm\/1771862","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T12:25:50Z","timestamp":1792585550000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beware the Muscle: Silent Exercise\u2010Induced Aminotransferase Elevation as a Diagnostic Pitfall in Hepatology and Pretreatment Screening\u2014A Report of Two Cases"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-6625-3764","authenticated-orcid":false,"given":"Chebet","family":"Chirchir","sequence":"first","affiliation":[{"name":"Department of Internal Medicine The Aga Khan University Hospital  Nairobi Kenya  aku.edu"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-3390-483X","authenticated-orcid":false,"given":"Antony","family":"Kimani","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine The Aga Khan University Hospital  Nairobi Kenya  aku.edu"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3653-1057","authenticated-orcid":false,"given":"Aaliya","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine The Aga Khan University Hospital  Nairobi Kenya  aku.edu"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9549-8267","authenticated-orcid":false,"given":"Adil","family":"Salyani","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine The Aga Khan University Hospital  Nairobi Kenya  aku.edu"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,21]]},"reference":[{"key":"e_1_2_12_1_2","doi-asserted-by":"publisher","DOI":"10.1056\/nejm200004273421707"},{"key":"e_1_2_12_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s13181-010-0075-9"},{"key":"e_1_2_12_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2025.03.018"},{"key":"e_1_2_12_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw376"},{"key":"e_1_2_12_5_2","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v26.i10.1020"},{"key":"e_1_2_12_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0065-2423(08)60362-5"},{"key":"e_1_2_12_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1984.03350050018012"},{"key":"e_1_2_12_8_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9010081"},{"key":"e_1_2_12_9_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-019-09185-4"},{"key":"e_1_2_12_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jshs.2015.01.012"},{"key":"e_1_2_12_11_2","doi-asserted-by":"publisher","DOI":"10.4161\/hv.1.1.1324"}],"container-title":["Case 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