B-22 Clinical Case Slide - Medicine I: JUNE 1, 2011 1:00 PM - 2:40 PM: ROOM: 505
HISTORY: A 34-year-old professional wrestler presents after testing positive for Hepatitis B Surface Antigen after routine 6 month company mandated infectious disease screening. He reports no abdominal pain, nausea, jaundice, fatigue or malaise. He had tested negative 6 months prior for both HIV and Hepatitis B Surface Antigen. He denied any history of IV drug use, unprotected sexual encounters, but does admit to frequently coming into contact with blood during multiple wrestling matches. The Company had no other positive screening tests among the other wrestlers.
PHYSICAL EXAMINATION: Well appearing 210 lb. athletic individual. No apparent jaundice or icterus. Abdomen was soft, non-tender, no ascites. No hepatosplenomegaly and the liver edge was not palpable.
DIFFERENTIAL DIAGNOSIS: 1. Hepatitis B, Acute
2. Hepatitis B, Chronic Immune Tolerant
3. Hepatitis B, Chronic Immune Active
4. Hepatitis B, Chronic Inactive Carrier
TEST AND RESULTS: -Hepatitis BeAG: Positive
-Bilirubin 1.2/Alk Phos 79/ALT 930/AST 189
-Hepatitis A IgM Ab: Nonreactive
-Hepatitis B Core Ab IgM: Reactive
-Hepatitis B Surface Ag: Reactive
-Hepatitis C IgG Ab: Nonreactive
-Hepatitis B PCR Quant: >110,000,000
FINAL WORKING DIAGNOSIS: Acute Hepatitis B
TREATMENT AND OUTCOMES: 1. Follow liver enzymes monthly. As these improve we will obtain Hepatitis B viral load and Hepatitis B Surface Antigen. If viral load persists longer than 6 months, treatment will be recommended.
2. Patient will not actively wrestle, but will continue with Company in non-contact television appearances. Upon documentation of zero viral load and negative Hepatitis B Surface Antigen will likely allow for full return to sport.