<s>[INST] hives on stomach and back on May 2nd. went away after second medrol pack. was fine until I wa getting big hives every day to every two days in random places including forearms elbows legs. I'm on Zyrtec and Zantac but seem to not help. today I went home early with severe fatigue neck pain and shoulder pain. tight chest as well started while I was on second medrol dose pack. rheumatologist is now testing blood again because liver enzymes are high. testing for viruses, could this be a case of mono? [/INST] Hi and thanks for the query,Abnormal liver function tests under such circumstances  need careful considerations. An enlarged or inflammed liver on its own could explain the shoulder pain, neck pain and fatigue. It s mandatory to know the cause of the raised liver enzymes. Hepatitis A, B C and D should be ruled out systematically. An abdominal ultrasound could be useful in getting the know the size of the liver and the spleen. It is very rare that this could be infectious Mononucleosis.  In IM, raised white blood cells are seen, enlarged lymph nodes and usually with spleen enlargement and not liver most of the time. It s not usual to have raised liver enzymes in this condition.I strongly suggest you consult your primary care physician and evaluation of your liver function.Kind regards,Bain LE, MD. </s>