A 29-yr-old Catholic priest returns from a trip to Brazil with fevers and deranged LFTs. He has an ALT of 2500 U/l and bilirubin of 75 μmol/l. He attended a travel clinic and was vaccinated prior to travel. He also took mefloquine malaria prophylaxis.
What is the most likely diagnosis?
A. Malaria
B. Hepatitis A
C. Hepatitis B
D. Hepatitis E
E. Dengue fever
Answer:
D--Hepatitis E
Discussion: Hepatitis E is the most likely diagnosis. Hepatitis A vaccine is routinely offered for the prevention of hepatitis A and is very effective. Acute hepatitis B would be less likely as it is transmitted by blood or sexual contact. Both malaria and dengue may cause deranged LFT but not to this level.
Hepatitis E has no chronic form but has a higher mortality (1–2%) than hepatitis A (0.1%) which has a similar clinical presentation and is also acquired by the faeco-oral route. Most deaths in patients with hepatitis E occur in women during the last trimester of pregnancy. Both hepatitis A and E may cause fulminant liver failure in patients with underlying liver disease.
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