CASE STUDY:
Retreatment/Treatment of Special Populations (normal ALT)

CLINICAL INFORMATION

HISTORY OF PRESENT ILLNESS

A 46-year-old woman, who had received multiple blood transfusions (36 units) in 1985 due to placental hemorrhage, sought medical advice when she was found to have a normal ALT but detectable hepatitis C virus (HCV) antibody by ELISA and RIBA methods. She recalled having received a letter from a blood bank requesting that she be tested for HCV because of the risk associated with a past history of blood transfusions. Her only symptom at presentation was mild fatigue, which improved with use of a daily multivitamin. Further testing revealed detectable serum levels of HCV RNA and an HCV genotype 1a.

PAST MEDICAL/SURGICAL HISTORY

She underwent a trans-abdominal hysterectomy at age 29 for placental hemorrhage following childbirth in 1985. In addition, she had a history of a positive tuberculin skin test (PPD) with an abnormal chest x-ray, for which she completed a 6-month course of treatment with isoniazid (INH) in 1982.

SOCIAL HISTORY

She is married, has one child, and works as a registered nurse. She does not drink alcohol and has never smoked. She denied the use of illegal drugs.

FAMILY HISTORY

The patient had no family history of liver disease.

MEDICATIONS/ALLERGIES

She takes a multivitamin on a daily basis and has no known drug allergies.

REVIEW OF SYSTEMS

The patient denied fatigue, fever, chills, night sweats, anorexia, weight loss, myalgias, arthralgias, cold intolerance, jaundice, nausea, vomiting, diarrhea, or abdominal pain.

PHYSICAL EXAMINATION

Vital Signs
Height	Weight	Temperature	Pulse	Blood Pressure	Respiratory Rate
4 ft 11 in	94.5 lbs	37° C	67 bpm	99/59 mm Hg	14/min

On physical examination, the patient appeared well. Examination of the abdomen was unremarkable, except for modest hepatomegaly with a nontender palpable liver edge approximately 7 cm below the right costal margin. There was no jaundice, spider telangiectases, tattoos, scleral icterus, ascites, pedal edema, or asterixis.