Want to take quizzes and track your credits?
An 18-year-old man from India who emigrated to the United States 4 weeks earlier presented with fever, malaise, and anorexia for 4 days. The patient reported ingesting no prescription, over-the-counter, or herbal medications; alcohol; or illicit drugs. On physical examination, he was afebrile and had scleral icterus and a palpable liver edge. Initial laboratory test results showed a white blood cell count of 3.9 × 103/μL and elevations in total bilirubin (5.6 mg/dL), direct bilirubin (3.6 mg/dL), alkaline phosphatase (240 U/L), aspartate aminotransferase (3322 U/L), and alanine aminotransferase (6114 U/L). His platelet count was 126 000 × 109/μL and prothrombin time was 17 seconds. Testing for viral hepatitis was performed (Table). Antinuclear, antismooth muscle, and liver/kidney microsomal antibodies were not detected. Immunoglobulin G (1294 mg/dL) and ceruloplasmin (22 mg/dL) levels were normal. Right upper quadrant ultrasonography demonstrated a liver span of 16 cm, a common bile duct measuring 0.3 cm, and patent hepatic vasculature.
Please finish quiz first before checking answer.
Read the answer below and download your certificate.
Read the discussion below and retake the quiz.
B. Anti–hepatitis E virus (HEV) IgM testing
Annually, an estimated 20 million cases of hepatitis E virus (HEV) occur worldwide.1 HEV is endemic in resource-limited countries and is typically caused by transmission of genotypes 1 or 2 via fecal-contaminated water.1 HEV accounts for many acute hepatitis cases in India.2 However, in resource-rich countries, HEV is rare; typically caused by genotypes 3 and 4; and results from ingestion of undercooked pig, boar, or deer meat.1 The annual estimated incidence in the United States from 1998 to 1994 was 0.7% per 1000 persons.3 HEV is typically self-limited and asymptomatic, but has a mortality rate of up to 20% in pregnant women and can lead to chronic infections in immunosuppressed individuals (eg, solid organ or bone marrow transplant recipients, individuals with HIV).1,3
Sign in to take quiz and track your certificates
JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC
Corresponding Author: Adam E. Mikolajczyk, MD, Division of Gastroenterology and Hepatology, University of Illinois at Chicago, 840 S Wood St, 1034 CSB, MC 716, Chicago, IL 60612 (firstname.lastname@example.org).
Published Online: February 13, 2020. doi:10.1001/jama.2019.21895
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient for providing permission to share his information.
You currently have no searches saved.