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


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

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