41 y.o. Vietnamese Male presents with a couple weeks of
yellow eyes, dark urine and several months of fatigue. Admits to taking Chinese
Medicines and moderately heavy alcohol intake. A couple occasions experimented
with IV heroin. Mother had Hep B and died of liver cancer. Was yellow prior to
dying.
Examination revealed jaundice, spider angiomata on upper trunk and palpably
enlarged liver.
Patient advised to reduce alcohol intake.
Bloods test reveal mild macrocytosis, mild thrombocytopenia, markedly elevated
bilirubin, non-specific elevations of GGT and ALP and 4-5 x normal ALT and AST.
Albumin mildly low. Hepatitis serology showed no acute infection and past EBV
infection.
Ultrasound demonstrates heterogenous liver echotexture with enlargement.
Referred to specialist. Further tests show normal iron studies, caeruloplasmin
and alpha 1 AT and aFP. ANA, LKM, SMA and AMA negative. HBeAg positive
LFTs improving after cessation of alcohol. Liver biopsy showed moderate to
severe abnormality.
Patient chooses to have entecavir orally but not interferon intravenously and
for monthly clinic followup
After several months, bloods test show viral load undetectable and normal ALT.
After one year, blood test show viral antibody response but lost to follow-up
Re-presents after several years because brother recently diagnosed with liver
cancer. aFP now positive and ultrasound demonstrates 2.5cm focal lesion.