A 50-Year-Old Woman With Massive Splenomegaly and Hepatitis C Infection
A 50-Year-Old Woman With Massive Splenomegaly and Hepatitis C Infection
from Medscape General Medicine [TM]
Posted
Author: Howard Hampel, MD
Series Editor: Richard Goodgame, MD
Case Presentation
The patient is a 50-year-old-woman who was well until 6 months ago when
she began having mild abdominal pain and decreased appetite. The pain was
constant, in the left upper quadrant, exacerbated by movement, and relieved
somewhat by rest. She had mild, early satiety but developed profound decreased
appetite such that she had lost 20 pounds during the previous 6-month period.
There was no dysphagia, dyspepsia, nausea, vomiting, altered bowel habits,
fever, or night sweats.
The patient used intravenous drugs briefly during her twenties and
thirties, but has not used for the last 20 years. She abused alcohol most of her
life but stopped drinking entirely 4 years ago. She has a stable family and
financial situation. There is no family history of serious illness.
Physical examination showed normal vital signs except for a temperature of
99.6ºF. There were no enlarged lymph nodes or skin lesions. There were no
peripheral stigmata of chronic liver disease. The head, ears, eyes, nose, and
throat were normal. Cardiac and pulmonary examinations were normal. The spleen
was massively enlarged, extending inferiorly to below the level of the umbilicus
and easily felt across the midline of the abdomen; it was soft and nontender.
The liver span was 10 cm by percussion; the edge was soft and smooth, easily
felt 2 cm below the right costal margin in the midclavicular line. The
neurologic examination was normal.
Results of routine laboratory studies revealed the following:
Hemoglobin, 10 g/dL
White blood cell count, 13 x 103 cells/mm3
Lymphocytes, 82%
Polymorphonuclear leukocytes, 15%
Platelets, 236 x 103/mm3
Mean corpuscular volume, 91 fL
Total protein, 5.5 g/dL
Albumin 3.1 g/dL
Total bilirubin, 1.1 g/dL
Direct bilirubin, 0.6 g/dL
Alkaline phosphatase, 177 U/L
Alanine aminotransferase (ALT), 111 U/L
Aspartate aminotransferase (AST), 47 U/L
Lactate dehydrogenase (LDH), 304 U/L
Prothrombin time, 12.6 sec
Viral serologies were negative for hepatitis A, hepatitis B, and HIV
markers, but were positive for hepatitis C virus (HCV) antibody. HCV RNA was
positive by polymerase chain reaction (
antinuclear antibody, alpha-1-antitrypsin, ceruloplasmin, alpha-fetoprotein, and
lipids, as well as results of iron studies, were normal or negative.