Toxoplasmosis and high Liver ALT

I am looking for a vet or qualified vet tech to offer a second opinion here. I rescued a cat about a year ago. A male kitty.."max". Max is about 2 years old. My vet found that his ALT numbers were high (239) when we did blood work about a year ago. All other blood work seemed normal. We thought maybe he ate something in the wild to elevate liver. We started max on Denamarin as a Liver supplement. We tested Max over the year and his ALT dropped to 167 on Denamarin. Normal is below 100. We decided to take him off Denamarin for a few weeks to see what would happen to ALT. ALT off Denamarin went back to 206. So we decided to get a second opinion on Liver ALT. Meanwhile Max is perfectly normal, eating/drinking well, gaining weight, normal stool and urine, super happy cat. The second vet decided that it would be good to just run a infectious disease panel on Max to see if maybe an underlying issue was causing high ALT. Everything came back normal recently on that panel. I mean everything from thyroid, to heart worm, to FELIV, to corona....etc. all normal. The only funky thing on this blood work was a Toxoplasmosis screening where IgG Antibody is 1:512 (<1:64) and the IgM is "negative" -- I dont know what 1:512 means but i heard this is high. this sounds like Max had exposure to Toxo in the past but doesn't have it now correct? Reason I ask is we have 2 other cats and everyone seems normal but I just want to be sure. Also, one vet thought I should put Max on Clindamycin for 30 days (harsh side effects I am reading) just to be safe. But from everything I am reading the presence of an antibody in the IgG is "good" at high and shows immunity and that he successfully fought off the Toxo in the past. Just like if you had a vaccine to something the titer might be high showing immunity. He is acting perfectly normal so we hate to give him a harsh medication just to be extra certain. All this doesn't answer the high ALT numbers though. Do you think the vet wanted to try Clindamycin with the hope it would make the ALT normal? Seems that everything I am reading is that elevated ALT is not a direct tie to past Toxo exposure. The two seem unrelated so why would we use Clindamycin?. More than likely high liver ALT is due to "inflammation" somewhere and that maybe another type of antibiotic should be tried. Should I be concerned about Toxo at all at this stage or just focus on trying to get the liver ALT down? Please, only respond if you have had experience with this and can answer from a vet perspective. Thank you!

I'm just bumping this thread up.  Sorry, no experience with this particular issue

We found Max about a year ago. We think he is about 2 years old. Max had been living outside and we think someone had dumped him off in the park behind where we live.He is definitely a lap cat that was trying to survive outside. When we got Max he was full of worms and fleas and was not neutered. So we took care of getting all these things resolved. At the time of his neuter a year ago, the vet did blood work and noticed that his ALT liver number was about 239. Vet thought maybe it was due to eating toxic things outside. So we put Max on Denamarin supplement that seemed to bring his values down to 167 during a 9 month period. 167 is still not normal but it is better. However if we take Max off Denamarin for a period which we have tried. His numbers jump back to 200. I need to mention that Max is acting NORMAL. Eating well, playing, stools/urine are normal, he is just one happy playful boy.  We started to get concerned about the liver numbers and our vet really couldn't explain what else to do so we took Max to another vet for a second opinion. That vet suggested we run an infectious disease panel. We had already ruled out Feline Leukemia prior..but we tested everything again. Everything including FELIV, corona, T4 (thyroid), heart worm, etc etc. came back negative. We discovered that Max had the antibody to Toxoplasmosis which was 1:512 which meant he had been exposed to Toxo probably from eating a rodent but he was now immune or built up an antibody to it. The second Toxo number was IgM negative so it clearly showed a past exposure not new. So we have no idea what could cause the elevated ALT. Should we keep chasing this to find out? Should we just keep him on Denamarin? Should we do an ultrasound (expensive)? Should we look into the idea that Toxo moved to his liver at some point?  Again, he is acting NORMAL. Does this sound familiar to anyone? HELP!

How well I can identify with what you are going through. My husband brought home a stray cat many years ago. He lived with us for several years. During one of his annual check ups, we decided to do a full blood panel to use as a reference point. The results came back much the same as your cat, only in the 300's. We did the same as you, tried the Denamarin. The liver numbers came down to just about normal, but he began vomiting all the time. We thought he was mourning the loss of one of our other cats. Finally we realized it was the medicine making him vomit. He was eating well, acting totally normal, just vomiting up his first meal of the day. We didn't do any kind of test, just stopped the Denamarin. We decided since he was acting to normal we wouldn't keep giving him a medicine to keep the numbers normal at the expense of making him vomit.

He lived a good number of years, until this past May a year ago (2012) with no problems. Then his appetite fell off considerably and he went for a vet check. An x-ray was done and a mass showed up in his abdominal area. The vet told us then that the options seemed to be, love him all you can, feed him whatever he will eat and wait for the end, do a CT scan which might show something definitive, or operate and see what was there with the understanding we might have already said goodbye to him, depending on what the vet saw. We chose that option as he was twelve years old then. The surgery went very well. A mass was found on the very tip of one of his liver lobes. Our vet was able to remove it all and send it to a lab for testing. It was a primary liver cancer. He was sewn up and recovered very well from the surgery. When he got well enough,we had to start him on thyroid medicine too. He also was started on prednisolone to help him feel better.

In May of 2013, his tumor had come back. At that time we decided now to put him through anything else. His prednisolone was increased. We fed him whatever he wanted. We held him, hugged him, and told him over and over how much he was loved. His battle with the cancer ended on Nov. 15. We did all we could do for him and he lived a long life, in spite of the high liver number.

I really don't know what we might could have done different because at the time of his first blood work, he seemed so normal. I think if we could do it over, I would have a CT scan done of his abdominal area and that might would have shown something then. But according to what our vet said, the scan is not always definitive. What have these two vets suggested as a treatment plan for your cat. It is a tough spot to be in.I would stick with which ever of the vet's I felt was the right one and work with him going forward with a treatment plan for your cat.

I am sorry this was so long. But I was trying to give you the knowledge of the route we chose and what the outcome was. I wish you well with your cat.