Table 1: Summary of patient labs and imaging.
Date | Lab |
1998 | HBsAg (+), HBV DNA < 0.0004 pg/mL |
10/1999 | Pt sustained severe car accident with multiple severe injuries, requiring surgeries and blood transfusion |
10/2000 | HBV DNA < 0.01 pg/mL
ALT 145 IU/L could have been due to HCV but anti-HCV was not tested |
11/2000 | HBsAg (+), anti-HBs (-), anti-HBc (+), HBeAg (-)/anti-HBe (-)
ALT 35 IU/L AFP 4 ng/mL Abdominal ultrasound: Liver with normal and homogeneous parenchyma |
No return for 9 years | |
7/2009
Sent by FMD for abnormal ALT |
ALT 163 U/L
HBsAg (+), anti-HBs (-), HBeAg (-)/anti-HBe (-) HBV DNA undetectable (< 100 IU/ml) AFP 7.2 ng/ml Abdominal MRI: Moderate to severe hepatic steatosis with no evidence of cirrhosis or HCC |
9/2009 | HBV DNA < 29 IU/mL |
3/2010 | ALT 71 IU/L
Since ALT continued elevated with negative HBV DNA, HCV was tested: Anti-HCV (+) with HCV RNA 1.75 × 104 IU/ml, HCV genotype 2 HBV DNA < 29 IU/m, Platelets 160 × 103/µL PegIFN + Ribavirin treatment for 6 months (9/2010-3/2011) |
7/2011 | HCV RNA (< 43 IU/ml) and HBV DNA (< 169 IU/ml) |
10/2011 | Abdominal MRI: 1.6 × 1.6 cm lesion in segment 8 that had T2 hyperintensity, arterial enhancement and washout consistent with HCC, minimally cirrhotic appearing liver
AFP 2.8 ng/ml ALT 40 IU/L Platelets 200 × 103/µL HBV DNA: 8.9 × 104 copies/ml (from a special lab) |