(Disclaimer: This article is for general use only, and the following information has been processed to protect patient privacy)
Abstract: The patient was a 38-year-old female admitted to our department via the emergency room because of nausea and vomiting for 3 days, and her liver function transaminases were elevated to more than 1000 U/L. After taking medical history and performing relevant tests, the diagnosis of acute viral hepatitis B was confirmed. After active medication and lifestyle modification, the patient’s liver function was normalized and her body was restored to health.
Basic information】Female, 38 years old
Disease Type】Acute viral hepatitis B
Hospital】The Second Hospital of Harbin Medical University
Date of consultation】March 2022
Treatment plan】Medication (diammonium glycyrrhizate injection + injectable reduced glutathione) + monitoring of hepatitis B surface antigen and hepatitis B DNA quantification + lifestyle modification (bed rest + light diet)
Treatment period] 11 days of hospitalization, 3 months of follow-up
Treatment effect] Liver function returned to normal, hepatitis B virus cleared from the body
I. Initial consultation
The patient had nausea and vomiting symptoms for 3 days, no special diet before that, no obvious abdominal pain and diarrhea, vomiting 4-5 times during that period, and symptoms of weakness, anorexia, and yellow urine. After checking the blood picture and liver function at a nearby clinic, he found that: glutamic aminotransferase 1339 U/L, glutamic aminotransferase 660 U/L, and total bilirubin 31.6 μmol/L. After admission, the patient was positive for hepatitis B surface antigen and elevated quantitative hepatitis B DNA. The diagnosis of acute viral hepatitis B was confirmed, so the patient was admitted to the hospital for treatment.
The diagnosis of the disease was unacceptable to both the patient and his family. The patient indicated that he had no previous history or family history of hepatitis B, but he would often go to some small clinics for acupuncture or plumbing. Since this disease can be transmitted through blood, it was considered that the needles used in some small clinics might have been repeatedly sterilized and incompletely disinfected, and the disease might have resulted from this.
Second, the treatment process
In response to the anxiety of the patient and family, in addition to reassurance, the patient was informed that the disease has a certain chance of self-healing, that most patients can automatically clear the hepatitis B virus without chronicity, and that treatment is based on liver preservation and enzyme reduction. After the analysis on the treatment plan, the patient and his family expressed their willingness to accept the treatment.
During the recovery process, the patient was instructed to stay in bed as much as possible, while choosing a light diet. The patient was then given aggressive liver-protective and enzyme-lowering therapy, including diammonium glycyrrhizinate injection and injectable reduced glutathione. Hepatitis B surface antigen and hepatitis B DNA quantification were also monitored.
III. Treatment effect
The hepatitis B surface antigen was low at the first recheck, dropping to 0.131 IU/ml, suggesting a high cure rate. On the fourth day of hospitalization, the patient’s symptoms improved significantly, with improved appetite and increased energy, and the liver function transaminase decreased to 425 U/L on the first week of rechecking. During the course of hospitalization, the patient’s surface antigen level gradually decreased, and the surface antibody changed from negative to positive at the time of discharge follow-up, and the quantification of hepatitis B virus DNA decreased to below the lower limit of detection.
IV. Notes
As a physician, I am thankful that this patient could be cured of hepatitis B. The fact that the patient has shown a surface antigen turn negative and surface antibodies at the same time during the follow-up visit suggests that the patient does not need to be retested in the future because having been infected with the hepatitis B virus and then cleared and produced antibodies, he will generally not be re-infected with hepatitis B in the future. It is recommended that patients should pay attention to proper exercise in their daily lives, avoid alcoholic beverages, go to bed early and wake up early, and eat fresh fruits and vegetables to help their liver health.
V. Personal insight
Acute viral hepatitis B currently has no specific drugs that can help patients clear the virus early, more by virtue of the patient’s own organism immunity to clear the virus. During this period, adequate rest and sufficient caloric intake are essential. In the early stage of the disease, the surface antigen and hepatitis B DNA quantification fall faster, the higher the chance of virus clearance, so it is necessary to monitor these two items in the early stage of acute viral hepatitis B infection, and once they turn negative at the same time, it indicates hepatitis B virus clearance.