Thank you Shirley for a great presentation on a young patient presenting with jaundice, AST 2552 and ALT >5000!

What’s the differential?

Here’s a quick differential diagnosis for transaminases >1000:

• Viral hepatitis
• Drug/Toxin-induced liver injury
• Autoimmune hepatitis
• Ischemic/Shock liver
• Budd-Chiari syndrome

It’s a narrow differential, so work it up with a good history and serologies.

In this case, Hepatitis B surface antigen and Hepatitis B core IgM antibody returned positive. The patient just needed supportive care and follow-up to ensure resolution of the acute hepatitis and viremia.