Case 312 Medical history 17 year-old male patient comes from Carmo da Mata (Minas Gerais) to the EC unit after hospitalisation due to hematemesis, melena, altered hepatic function and low level of platelets. No other comorbidities. Denies alcohol intake, smoking or use of recreational drugs. Denies any contact with fresh water. Physical examination reveals hepatomegaly and pain during right hypochondrium palpation. Requestes Upper Gastrointestinal Endoscopy (Image 1) and laboratorial review (Image 2) to diagnostic elucidation. Image 1: Upper Gastrointestinal Endoscopy, picture of the oesophagus. Image 2: Laboratorial review with results and normality range. Altered tests in bold. Abbreviations: RNI = international normalized ratio; PTTa: activated partial thromboplastin time; AST = aspartate aminotransferase; ALT = alanine aminotransferase; Gama-GT = gamma-glutamyltransferase; Anti-LKM1 =liver kidney microsome type 1 antibody; ASMA = anti-smooth muscle antibody; FAN = anti-nuclear antibody. Question:Considering the clinical data, the results and that viral serology were negative to Hepatitis B and C, which one is the most likely diagnosis? a) Wilson's disease b) Primary sclerosing cholangitis c) Type 1 autoimmune hepatitis d) Type 2 autoimmune hepatitis Test question (Medical Residence 2009 - UFF) Young patient, with history of jaundice and recurring pruritus, shows elevated transaminases over 5 times the normal range, gamma-GT and alkaline phosphatase over 1,5 times normal range, HAV serology negative, negative HBsAg, positive Anti-HBs, positive HBc, positive anti-HCV, hypergammaglobulinemia and positive Anti-LKM1. The most likely diagnosis is: a) Acute hepatitis C b) Chronic hepatitis B c) Autoimmune hepatits d) Primary sclerosing cholangitis e) Primary billiar cholangitis Time is Up! Time's up
