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 Best of Five 3.23

 

   

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BOF: 3.23

A 35-year-old female presented with a history of lethargy and jaundice. She also complained of joint pains and mild pain in the right upper quadrant.

She did not drink and did not take any medications including over the counter preparations or herbal remedies.

On examination the patient was not obese, she had mild jaundice and the liver was enlarged 3 fingerbreadths below the costal margin and was tender.

Investigations revealed normal haematology raised ALT, ALP and bilirubin.

Gammaglobulin levels were raised and she was positive for ANA and SMA antibodies.

She was negative for hepatitis B and C viruses and screening for haemochromatosis, Wilsonís disease and alpha antitrypsin deficiency was negative.

Ultrasound scanning did not reveal a focal lesion.

Liver biopsy was performed and this showed a lymphoplasmacellular infiltrate in the portal tracts with necrosis affecting the limiting plate.

In this patient:

a)      Selective elevation of Ig G antibody is typical

b)      Selective elevation of Ig A antibody is typical

c)      Selective elevation of Ig M antibody is typical

d)      Positive anti SMA is diagnostic of this condition

e)      Positive anti LKM antibody is diagnostic of this condition

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