A 23-year-old man comes to the physician due to a 2-month history of fatigue, malaise, and abdominal discomfort. He is found to have tender hepatomegaly with elevated liver function tests. The patient has never been vaccinated against hepatitis. He has had no raw or uncooked foods recently and recalls no ill contacts. There is no history of blood transfusion. The patient is a graduate student who immigrated to the United States 2 years ago and has not traveled outside the country since. He smokes 2 packs of cigarettes a day and consumes 1 or 2 bottles of beer on weekends. The patient does not use illicit drugs. He has had several episodes of unprotected sex with different female partners within the past year. Which of the following is most likely to be present in this patient?

Question

A 23-year-old man comes to the physician due to a 2-month history of fatigue, malaise, and abdominal discomfort.  He is found to have tender hepatomegaly with elevated liver function tests.  The patient has never been vaccinated against hepatitis.  He has had no raw or uncooked foods recently and recalls no ill contacts.  There is no history of blood transfusion.  The patient is a graduate student who immigrated to the United States 2 years ago and has not traveled outside the country since.  He smokes 2 packs of cigarettes a day and consumes 1 or 2 bottles of beer on weekends.  The patient does not use illicit drugs.  He has had several episodes of unprotected sex with different female partners within the past year.  Which of the following is most likely to be present in this patient?

Quizplus · Accepted Answer

The main modes of transmission of hepatitis B virus (HBV) are sexual (transmission among heterosexual partners and among men who have sex with men) and percutaneous (eg, intravenous drug use, needlestick accidents, blood transfusions). Vertical (mother-to-child) transmission is common in high-prevalence areas. This unvaccinated patient with tender hepatomegaly and liver function abnormalities most likely has acute HBV infection contracted during an episode of unprotected sex (most common mode of transmission in developed countries, >70% of cases). Serum hepatitis B surface antigen (HBsAg) would be present. Anti-HBsAg immunoglobulin G (IgG) appears after either successful HBV vaccination or HBsAg clearance and remains detectable for life (indicator of non-infectivity and immunity). Because this patient is symptomatic, he obviously has not cleared the virus and would likely not yet have anti-HBsAg IgG (Choice C). (Choices A and B) Hepatitis A virus (HAV) in the stool or serum anti-HAV IgM would be expected with acute HAV following recent travel to an endemic area or consumption of tainted, insufficiently heated food (eg, oysters). HAV (fecal-oral transmission) is not usually symptomatic for 2 months and is not associated with a chronic carrier state. (Choice E) Hepatitis C virus (HCV) infection is most often asymptomatic. Also, most HCV transmission occurs in the setting of intravenous drug use. Sexual transmission of HCV can occur but is inefficient; the risk is actually low (eg, incidence of 0.07% per year in a study of 500 heterosexual couples) and would be lower than that of HBV transmission. (Choice F) Hepatitis D virus (HDV) transmission occurs primarily through inoculations and blood transfusions, with sexual transmission far less common. Co-infection with HBV or superinfection of chronic HBV is necessary. Globally, only about 5% of HBV carriers also have HDV (rates vary based on geography). Educational objective: The main modes of transmission of hepatitis B virus include sexual (among both heterosexual partners and men who have sex with men) and percutaneous (eg, intravenous drug use, needlestick accidents, blood transfusions). The risk of sexual transmission of hepatitis C virus is low.

A 23-Year-Old Man Comes to the Physician Due to a 2-Month