Acute viral hepatitis type C Chapter 2 Viral Hepatitis 1 Acute viral hepatitis type C Case 2.2

Clinical Presentation 2 Viral Hepatitis 2 Clinical Presentation A 49-year-old woman with a history of asthma and chronic back pain from an accident years ago, necessitating multiple surgeries, presented with abnormal liver tests during her workup for the back pain. She was on no medications other than Vicodin for the pain. She had no history of previous liver abnormalities.

Laboratory Values Course in Hospital AST: 627 Total Protein: 6.0 Viral Hepatitis 3 Laboratory Values AST: 627 ALT: 1150 Alk Phos: 270 Total Bilirubin/Direct: 0.9/0.7 Total Protein: 6.0 Albumin: 3.4 Serologies: HBsAg, ANA, HIV: Negative Anti-HCV: Positive Course in Hospital She was assessed as having an acute hepatitis, most likely HCV related. It also was not felt that she had a chronic HCV with reactivation, but a liver biopsy was performed to assess whether fibrosis and hence a chronic liver disease might be present.

2 Viral Hepatitis 4 Pathology All of the portal tracts were normal in size to expanded, without fibrosis, and exhibited a prominent predominantly lymphocytic infiltrate with normal interlobular bile ducts (a). The parenchyma exhibited diffuse moderate necroinflammatory change uniformly throughout all of the lobules (b). Figure 2.2(a) Figure 2.2(b)

Diagnosis Acute viral hepatitis secondary to HCV infection 2 5

2 Viral Hepatitis 6 Comment This is an example of the diagnosis of acute HCV being made incidentally during an office visit for chronic back pain, with the patient not exhibiting any symptoms related to the liver disease. <20% of patients with acute HCV are symptomatic which can include jaundice; the diagnosis of acute hepatitis therefore is often initially unexpected, as in the present case example. A fulminant course is exceptionally rare in acute HCV; however recovery of the acute hepatitis more often than not results in chronic HCV, this occurring in up to ⅔ of adults and in about ½ of children after acute infection. Therefore follow-up in this patient is essential for monitoring and early treatment if chronicity develops.