A 27-year-old woman without pertinent medical history presented with elevated transaminase levels and a positive hepatitis B surface antigen (HBsAg) test result. Hepatitis B surface antibody (anti-HBs) testing was initially performed 11 months after hepatitis B virus (HBV) vaccination to assess immunologic response before beginning nursing school. Because of elevated liver enzymes and lack of anti-HBs following vaccination, further serologic testing was performed (Table).
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At presentation, the patient was asymptomatic. Physical examination findings were unremarkable. The patient was born in Albania and did not receive the HBV vaccination in childhood. She reported 2 heterosexual partners in her lifetime. She had no history of other sexually transmitted infections, blood transfusions, needlestick injuries, or intravenous drug use.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Maroun M. Sfeir, MD, MPH, MS, Department of Pathology and Laboratory Medicine, Clinical Microbiology Laboratories, University of Connecticut Health Center, Farmington, CT 06053 (firstname.lastname@example.org).
Published Online: November 19, 2021. doi:10.1001/jama.2021.19803
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient for granting permission to publish this information.
Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
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