A thirty-year man presented with nausea, fever and jaundice of 5-days duration. The biochemical tests revealed a bilirubin of 6.7 mg/dl (conjugated 5.0 mg/dl) with SGOT/SGPT (AST/ALT) of 123/900 IU/ml. The serological tests showed presence of HBsAg, IgM anti-HBc and HBeAg. The most likely diagnosis is:

Question

Image below highlights jugular foramen. Which of the following structures do not pass through the marked structure “A”?

Answer 1

This question is testing how to read hepatitis B serology together with the clinical picture to stage the infection and judge how infectious the patient is. Let's look at each option.

Chronic hepatitis B infection with high infectivity: Chronic infection would show IgG anti-HBc, not IgM. The short 5-day history and very high ALT of 900 also argue against a chronic, longstanding process, so this does not fit.
Acute hepatitis B infection with high infectivity: IgM anti-HBc marks a recent, acute infection, and HBeAg positivity marks active viral replication and high infectivity. Both markers plus the short symptomatic history fit an acute, highly infectious hepatitis B.
Chronic hepatitis B infection with low infectivity: Low infectivity chronic hepatitis B is the HBeAg negative, anti-HBe positive inactive carrier state. This patient is HBeAg positive, not HBeAg negative, so this does not fit.
Acute hepatitis B infection with low infectivity: The infection is acute, which is right, but HBeAg positive means high infectivity, not low, so this option is only half correct.

The IgM anti-HBc confirms the infection is acute, and the HBeAg confirms it is highly infectious, so the picture matches acute hepatitis B with high infectivity.

Let's summarize:

IgM anti-HBc means acute or recent infection; IgG anti-HBc means past or chronic infection.
HBeAg positive means high viral replication and high infectivity.

So the correct diagnosis is acute hepatitis B infection with high infectivity, option (2).

Answer 2

This question is testing how to read hepatitis B serology together with the clinical picture to stage the infection and judge how infectious the patient is. Let's look at each option.

Chronic hepatitis B infection with high infectivity: Chronic infection would show IgG anti-HBc, not IgM. The short 5-day history and very high ALT of 900 also argue against a chronic, longstanding process, so this does not fit.
Acute hepatitis B infection with high infectivity: IgM anti-HBc marks a recent, acute infection, and HBeAg positivity marks active viral replication and high infectivity. Both markers plus the short symptomatic history fit an acute, highly infectious hepatitis B.
Chronic hepatitis B infection with low infectivity: Low infectivity chronic hepatitis B is the HBeAg negative, anti-HBe positive inactive carrier state. This patient is HBeAg positive, not HBeAg negative, so this does not fit.
Acute hepatitis B infection with low infectivity: The infection is acute, which is right, but HBeAg positive means high infectivity, not low, so this option is only half correct.

The IgM anti-HBc confirms the infection is acute, and the HBeAg confirms it is highly infectious, so the picture matches acute hepatitis B with high infectivity.

Let's summarize:

IgM anti-HBc means acute or recent infection; IgG anti-HBc means past or chronic infection.
HBeAg positive means high viral replication and high infectivity.

So the correct diagnosis is acute hepatitis B infection with high infectivity, option (2).

Show Hint

The Correct Option is B

Solution and Explanation

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