CASE
A 17-year-old male presented with a 1-week history of fatigue and jaundice. The patient's jaundice was preceded by 1 week of sore throat, cough, and congestion but no fever. He reported dizziness with postural changes and easy fatigability. No weight loss, night sweats, or rashes had occurred. Blood testing revealed elevated liver function levels, and a CBC revealed a hemoglobin level of 9.7 g/dL. The patient was then lost to follow-up until he returned 6 weeks later with worsening fatigue, vague intermittent abdominal pain, and persistent jaundice. He denied pruritus but reported darkening of his urine and some swelling in both his feet. His upper respiratory tract symptoms had resolved. During the past few weeks, he reported difficulty paying attention and staying awake in class.
The patient's personal and family histories were significant only for jaundice, which his mother had had. He did not take any medications. On examination, the patient's vital signs were normal. Pallor was evident. Chest and cardiac examination were both unremarkable. His abdomen was soft, mildly tender in the right upper quadrant, and negative for Murphy sign. No hepatomegaly was detected, but his spleen tip was palpable 3 cm below the left costal margin. He was oriented to person, place, and time. Laboratory results revealed a total and direct bilirubin of 15.8 mg/dL and 9.2 mg/dL, respectively. His AST level measured 575 U/L and his ALT level was 708 U/L. Renal function and electrolytes were within normal limits.