GIM Question 38 Instructor

A 55-year-old man is admitted to hospital with fever, nausea, anorexia and jaundice. He admits to a 1-year history of IV drug use.

1. What is your differential diagnosis for this patient?
   Jaundice in an adult patient has a differential that includes hepatic, biliary and pancreatic causes. In conjunction with the patient’s other symptoms, the differential diagnosis includes:
   • Acute hepatitis A/B/C
   • Cholangitis
   • Cholecystitis
   • Pancreatitis
2. Assuming this is acute hepatitis B, what specific serological markers would you expect to see in this patient?
   Hepatitis B viral serological markers can assist in determining the acuity of a hepatitis B infection:
   • Acute infection: HBsAg positive, anti-HBc positive, IgM anti-HBC positive, anti-HBs negative
   • Chronic infection: HBsAg positive, anti-HBc positive, IGM anti-HBc negative, anti-HBs negative
   • Immunity due to vaccine: HBsAG negative, anti-HBc negative, anti-HBs positive
   • Immunity due to prior infection: HBsAg negative, anti-HBc positive, anti-HBs positive

   As the patient in this case has an acute hepatitis B infection, the following serological markers are expected:

   • HBsAg positive, anti-HBc positive, IgM anti-HBC positive, anti-HBs negative

Resources

1. Centers for Disease Control and Prevention. Interpretation of Hepatitis B Serologic Test Results. Retrieved from: http://www.cdc.gov/hepatitis/HBV/ProfResourcesB.htm.
2. Roche SP and Kobos R. Jaundice in the Adult Patient. Am Fam Physician. 2004;69:299-304.