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Abstract: A 45-year-old male patient was admitted to the ward with “liver injury” after he noticed yellow eyes and skin three days ago and showed elevated liver function indicators at the outpatient clinic. During hospitalization, the patient was diagnosed with acute hepatitis C after examination revealed that he was positive for hepatitis C core antigen and hepatitis C virus RNA. After drug treatment, the patient’s liver function improved significantly, the virus cleared, and the nucleic acid of hepatitis C virus turned negative.
Basic information】Male, 45 years old
Type of disease】Acute hepatitis C
Hospital】The Second Hospital of Harbin Medical University
Date of consultation】July 2020
Treatment plan】Medication (magnesium isoglycyrrhizate injection, reduced glutathione for injection, adenosine methionine butadisulfate for injection, pantoprazole sodium enteric capsule, sofosbuvir-velpatasvir tablets)
[Treatment period] 1 month of hospitalization and 3 months of antiviral treatment
Treatment effect】Symptoms relieved, liver function normalized, hepatitis C virus nucleic acid turned negative
I. Initial consultation
The patient was 45-year-old Mr. Song, who was in poor general condition when he came to our hospital. He had a fever 10 days before the onset of the disease, with a maximum temperature of 38°C. At that time, there was no obvious cough or sputum, so he thought it was a cold and did not take any medicine. After that, his condition became worse and worse, and he gradually developed a series of symptoms such as weakness, nausea, abdominal distension, aversion to grease, etc. The color of urine also deepened to a strong tea color, and at the same time, he had a feeling of distension and pain under the left rib cage. Examination showed that the patient had slight pressure pain in the upper abdomen as well as in the right upper abdomen, without rebound pain.
This patient’s initial diagnosis was acute jaundice, and further investigation of the cause of the patient’s liver injury was required. I then asked the patient for some relevant medical history, and the patient indicated that there was no family history of liver disease and no recent use of specific medications or exposure to chemicals. Therefore, infectious factors were still considered, and further tests were arranged for the patient. Cytomegalovirus, EBV, and rubella virus IgM were negative, hepatitis series were negative, hepatitis C core antigen test was positive, and hepatitis C virus RNA was positive, and the final diagnosis was acute hepatitis C. Therefore, he was admitted to the hospital for treatment.
II. Treatment history
The patient’s symptoms were still obvious during admission, and the patient was given symptomatic treatment of liver protection and anti-yellowness. To promote liver metabolism and protect cell membranes, magnesium isoglycyrrhizate injection, reduced glutathione for injection, adenosylmethionine butadisulfate for injection and other drugs were used. At the same time, for the patient’s intermittent nausea and vomiting, the patient was given pantoprazole sodium enteric capsules as symptomatic treatment. After the diagnosis of acute hepatitis C, sofosbuvir-velpatasvir tablets were given for antiviral treatment.
III. Treatment effect
The patient’s symptoms of malaise and nausea were relieved after the 1st week of drug use, but he still did not eat much. A repeat liver function test revealed that there was still a small increase in bilirubin level, and subsequently liver-protective and anti-yellowness treatment was continued. At the 2nd recheck, transaminases and total bilirubin gradually began to decrease. Starting from the 3rd week, the patient’s urine yellow gradually became lighter, and his appetite and sleep improved. After 1 month of hospitalization and when ready for discharge, the patient was retested for hepatitis C virus RNA quantification and the viral nucleic acid was no longer detectable. At the same time, the hepatitis C antibody was positive, confirming that hepatitis C was an acute infection and suggesting a better antiviral effect. In order to avoid chronicity of hepatitis C and complete eradication of viral replication, the patient was advised to be antiviral for 3 months, followed by close rechecking as well.
IV. Precautions
The patient’s condition is controlled and the adverse symptoms gradually disappear after the treatment, as the doctor is happy for the patient and his family. After being discharged from the hospital, it is recommended that patients should get enough rest, avoid staying up late, and can reduce exercise and work appropriately; in terms of diet, they can eat more light and easily digestible foods, such as common ones as millet porridge and noodle soup. Pay attention to quit smoking and keep a good mood to help your health. After discharge from the hospital, if nausea, anorexia and yellow staining occur again, you should visit the doctor for review in time to avoid recurrence of the disease.
V. Personal insight
The positive rate of hepatitis C antibody is only 50-70% in the early stage of acute hepatitis C virus infection, and it can rise to more than 90% at 3 months after infection. Therefore, diagnosis based on hepatitis C virus antibodies alone may result in misdiagnosis or missed diagnosis. If hepatitis C virus infection is suspected, as in this patient, the hepatitis C core antigen can be checked to increase the chances of diagnosis and serve as an early diagnostic basis for acute hepatitis C virus infection.