Case Studies

 Case 14.5 Hepatitis A

An 18-year-old man presented with a 10-day history of anorexia, nausea and upper abdominal discomfort. Two weeks earlier, he had experienced some mild arthralgia in his fingers which lasted for 2 days. He normally smoked 20 cigarettes and drank two to three pints of beer each day, but had done neither for several days. He had noticed that his urine was much darker than normal. There was no significant medical history. On examination, he was afebrile but jaundiced. There were no needle tracks on his arms. His liver was just palpable and tender.

Hepatitis was diagnosed and confirmed by routine investigations. His serum bilirubin was 48µmol/l (NR 1-20) with raised liver enzyme levels (aspartate transaminase 895iu/l (NR 5-45); alanine transaminase 760iu/l (NR 5-30)), and an alkaline phosphatase of 128iu/l (NR 20-85). A monospot test for infectious mononucleosis was negative. Hepatitis B surface antigen (HBsAg) was also negative but he had detectable IgM antibodies to hepatitis A virus. He was managed conservatively at home. There is no active treatment for hepatitis A infection, although rest may be beneficial. The clinical and biochemical evidence of hepatocellular damage subsided over the next 4 weeks but he continued to feel vaguely unwell for several months. A further blood sample after 6 months showed IgG antibody to hepatitis A.