CASE STUDY:
Retreatment/Treatment of Special Populations
(patient from a different ethnicity)

CLINICAL INFORMATION

HISTORY OF PRESENT ILLNESS

A 61-year-old African-American male with chronic hepatitis C virus infection (HCV), diagnosed 6 years prior, presented for a second opinion regarding HCV treatment. He acquired the HCV infection from prior intravenous drug use. Four months ago, he was offered treatment for his HCV by an internist, but he declined therapy due to its known adverse side effects. He denied any prior history of jaundice, ascites, edema, variceal bleeding, or hepatic encephalopathy. He noted a one-month history of some right upper quadrant discomfort, not associated with meals. He reported a history of alcohol consumption, but has remained sober since August of 1988. This was also when he last used intravenous drugs.

PAST MEDICAL HISTORY

His past medical history included systemic hypertension and benign prostatic hypertrophy. A liver biopsy performed in 1998 revealed chronic HCV with interface and lobular activity, and probable cirrhosis with mild iron deposition.

SOCIAL HISTORY

He is a veteran of the armed forces, having previously served in the Air Force. He is married and works as a salesman. He previously used intravenous drugs and crack cocaine. He also previously drank heavily until August of 1988.

FAMILY HISTORY

His family history is unremarkable for liver disease. He has 5 healthy children.

MEDICATIONS/ALLERGIES

His current medications include diltiazem 360 mg QD, metoprolol 100 mg QD, allopurinol 300 mg QD, naproxen 550 mg BID, tamsulosin 0.4 mg QD. He has no known drug allergies.

PHYSICAL EXAMINATION

Vital Signs
Height	Weight	Temperature	Pulse	Blood Pressure	Respiratory Rate
5 ft. 9 in.	237 lbs.	36.4° C	64 bpm	118/72 mm Hg	20/min

On physical examination, the patient is a moderately obese male in no apparent distress. He had no appreciable outward signs of liver failure such as scleral icterus, ascites, pedal edema, vascular spider, or asterixis. His abdomen was soft and nontender with active bowel sounds. He had no appreciable shifting, dullness, or hepatosplenomegaly. There were no hernias or superficial abdominal collaterals.