A 26-year-old man comes to the physician because of a one-week history of diffuse abdominal pain. His temperature is 39.1°C (102.3°F). Physical examination shows numerous scars and excoriations along both arms, scleral icterus, and tender hepatomegaly. He is not married and has a history of multiple heterosexual partners. The patient recently stopped smoking, drinks alcohol socially and does not use illicit drugs. Physical examination is notable for a moderately enlarged and tender liver. No jaundice is seen. Laboratory studies show significant elevations in serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Which of the following is the most likely diagnosis in this patient?

Question

A 26-year-old man comes to the physician because of a one-week history of diffuse abdominal pain. His temperature is 39.1°C (102.3°F). Physical examination shows numerous scars and excoriations along both arms, scleral icterus, and tender hepatomegaly. He is not married and has a history of multiple heterosexual partners.  The patient recently stopped smoking, drinks alcohol socially and does not use illicit drugs.  Physical examination is notable for a moderately enlarged and tender liver.  No jaundice is seen.  Laboratory studies show significant elevations in serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST).  Which of the following is the most likely diagnosis in this patient?

Quizplus · Accepted Answer

Eductional Objective: Acute hepatitis B infection can cause a serum sickness-like syndrome with joint pain, lymphadenopathy, and a pruritic urticarial rash.  Other features may include right upper quadrant pain, hepatomegaly, and elevated hepatic transaminase levels.

A 26-Year-Old Man Comes to the Physician Because of a One-Week