كليدواژه :
B ويروس هپاتيت , HBsAg Chronic Carrier , پزشكي , هپاتيت حاد پارانشيماتوز
چكيده لاتين :
A 24 year-old male student with a chronic HBV healty carrier history: came to a private clinic, because of dark urine, yellow sclera, nausea, loss of apetite and a painful liver when it was palpated by the physician. The patient had fever since a week ago. In pharyngeal examination, exudative amigdalitis with edema and red tissue infiltration was found. In liver examination, it was felt, two centimeter below the ribs, and spleen at left side was palpable. Giant lymphnodes were seen in both sides of neek, but on no other sites. Maculopapular exanthemas were present on the skin of chest and anterior portion ofneek.
The patient complained of abdominal dis-comfort, myalgia and mild weakness but no arthralgia. He had mild dizziness and on third day of his fever, he noticed that his urine was dark brown colour and the day after, urine discolauration, he awoke with yellow discolouration of his eyes and skin. Because of history of HBsAg chronic, carriery he had taken some herbal supplements and had swallowed several alive river fishes. His pulse was 98 beats per minute with blood pressure of 120/70 mm Hg. His respiratory rate was 22 beats perminute. An early systolic murmur was present at the right upper stemal border. On auscultation his lungs were normal. The remainder of his physical examination was normal.
The white cell count was 13, 250 per cubic millimeter, platelet count 175000 per cubic millimeter. The hemoglobulin 9.5 g per decilitre, the reticulocyte count was 1.5 percent.
The total Bilirubine level was 8.5 mg per decilitre, ALT 450, SLT 400, LDH level 190 (normal up-to 180).
Urine test was negative for blood. Viral serological tests for hepatitis A, C and D were negative, HBeAg was negative, HBeAb and total anti HBC antibodies tests were positive.
The activity of G6PD was normal. HDV infection, particulary super infection, is associated with a risk of acute hepatitis. The differentiation between acute and chronic HDV infection is typically made by serologic markers including the presence or absence of lgM, anti HBC and lgM or lgG antibodies to HDV. In this patient with an old history of chronic carrier of HBV and an acute form of paranchymal hepatitis, super infection of HDV infection was suspected, but it was negative by performing of HDV antibody. A peripheral blood smear for morphology of WBC was done and then a diagnostic procedure was performed.
