Problem 36 A young woman with jaundice
A 25-year-old woman presents with a 2-week history of general malaise. She had developed a sore throat and fever followed by nausea and diarrhoea. She has vomited and has been eating little. Yesterday, a friend noticed that her eyes had turned yellow. Her urine has turned dark brown but she has not noticed what colour her bowel motions are.
She is thin, jaundiced and looks unwell. She has tattoos, puncture marks in her antecubital fossae and tracks along the lines of her veins in her forearms. She has no lymphadenopathy. Cardiovascular and respiratory examinations are normal. Her abdomen is soft without ascites. Her liver is palpable 4 cm below the costal margin and is smooth and tender. The spleen is not palpable. There are no stigmata of chronic liver disease. She is not encephalopathic. Her urine is positive for ketones and bilirubin.
The results of some initial investigations are as follows:
The following results become available:
Investigation 36.2 Ultrasound of liver
Investigation 36.3 Department of virology
| Anti-hepatitis A IgM: | Negative |
| Hepatitis B surface antigen: | Positive |
| Anti-hepatitis B core IgM: | Positive |
| Anti-hepatitis C IgG: | Negative |
| Hepatitis C antibody: | Positive |
| Hepatitis C viral PCR: | Negative |
| HIV antibody: | Negative |
Liver synthetic function remains normal. She remains nauseated and finds it difficult to eat.
Investigation 36.5 Son’s test results
| Virology | |
| Hepatitis B surface antigen: | Negative |
| Anti-hepatitis B surface IgG: |
