A previously healthy, 22-year-old woman - maddy143

[ArchivalUser]

A previously healthy, 22-year-old woman comes to medical attention because of

mild jaundice,
low-grade fever,
arthralgia, malaise,
and amenorrhea for 3 months.
She does not drink alcohol or smoke.
She does not take any medications other than oral contraceptives.
Serum chemistry studies show elevated AST and ALT levels, hypergammaglobulinemia, and high titers of circulating antinuclear and anti-smooth muscle autoantibodies. Serologic studies of antibodies to hepatitis viruses are as follows:
HAV Negative
HBV Negative
HCV Positive, by enzyme immunoassay
HCV Negative, by recombinant immunoblot assay (RIBA)
A liver biopsy demonstrates lymphocytic portal inflammation with early bridging necrosis.
Which of the following is the most likely diagnosis?

A. Autoimmune hepatitis


B. Chronic hepatitis C


C. Hepatic adenoma


D. Nonalcoholic steatohepatitis


E. Primary biliary cirrhosis

[ArchivalUser]

E. Primary biliary cirrhosis

[ArchivalUser]

correct answer is A

[ArchivalUser]

kkk..missed the theme completely...tx

[ArchivalUser]

AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA

The Explanation:
Clinical symptomatology and laboratory findings are consistent with chronic "autoimmune" hepatitis (AH). The biopsy findings support this diagnosis, demonstrating portal inflammation with lobular damage resulting in bridging necrosis. The young age of the patient and presence of hypergammaglobulinemia are also common in this condition. There are two major types of AH. Type I, or the classic type, is the most frequent; it is associated with antinuclear and anti-smooth muscle autoantibodies. Type II, which is more common in women of Western European descent, is associated with autoantibodies to circulating liver-kidney microsomes. The onset is usually insidious, and a history of amenorrhea is frequently present.

Chronic hepatitis C (choice B) develops in 80% of cases of hepatitis C virus infection. It may manifest years after the often-asymptomatic acute infection with signs and symptoms of chronic hepatitis or liver failure. The diagnosis is confirmed by positive enzyme immunoassay test for HCV-antibodies. However, this test may be falsely positive in situations with hypergammaglobulinemia. In such cases, positivity should be confirmed by a more specific RIBA. In this case, RIBA was negative, ruling out hepatitis C.

Hepatic adenoma (choice C) is a benign hepatocellular neoplasm associated with use of oral contraceptives or anabolic androgens. It is usually clinically silent but may occasionally manifest with life-threatening peritoneal bleeding.

Nonalcoholic steatohepatitis (choice D) mimics alcoholic hepatitis both clinically and histopathologically. It is characterized by fatty change of the liver with associated laboratory signs of hepatocellular injury. Obesity and diabetes are the most common predisposing conditions.

Primary biliary cirrhosis (choice E) has a predilection for middle-aged women. It manifests with progressive signs of cholestasis, in which pruritus and xanthomas are often the earliest signs. Antimitochondrial autoantibodies are found in 90% to 95% of these patients.