Hepatitis B in a 35-Year-Old Male
Hepatitis B is a viral infection that affects the liver and can present as an acute illness with symptoms such as fatigue, loss of appetite, nausea and jaundice. While many immunocompetent adults recover completely, some cases require close monitoring to identify complications or progression to chronic infection.
Early diagnosis through clinical assessment and appropriate serological testing is essential for guiding management, preventing transmission, and ensuring timely follow-up.
Patient Information
- Age/Sex: 35-year-old male
- Occupation: Business professional
- Presentation: Abnormal liver function tests and fatigue
Chief Complaints
The patient presented with:
- Fatigue for 3 to 4 weeks
- Reduced appetite
- Mild nausea
- Right upper abdominal discomfort
- Dark-coloured urine for 5 days
- Mild yellowish discolouration of the eyes for 3 days
There was no history of haematemesis, melaena, altered sensorium or abdominal distension.
Relevant History
The patient had no previous diagnosis of liver disease.
He reported undergoing a medical procedure several years earlier but was unsure about his previous Hepatitis B vaccination status.
There was no history of intravenous drug use or hepatotoxic medication use.
He consumed alcohol occasionally.
Family History: No known chronic liver disease.
Clinical Examination
On examination, the following findings were noted:
- Temperature: 98.6°F
- Pulse: 84/min
- Blood Pressure: 118/76 mmHg
- SpO₂: 98% on room air
The patient was conscious and oriented.
Mild icterus was present.
There were no signs of chronic liver disease such as:
- Ascites
- Pedal oedema
- Spider angiomas
- Palmar erythema
- Hepatic encephalopathy
Abdominal examination revealed mild right hypochondrial tenderness, and the liver was palpable just below the costal margin.
Diagnostic Assessment
Laboratory investigations revealed:
Investigation | Result |
Haemoglobin | 14.2 g/dL |
TLC | 6,400/µL |
Platelets | 1.85 lakh/µL |
ALT | 846 U/L |
AST | 672 U/L |
ALP | 168 U/L |
Total bilirubin | 6.2 mg/dL |
Direct bilirubin | 4.8 mg/dL |
Albumin | 4.0 g/dL |
INR | 1.1 |
Creatinine | 0.9 mg/dL |
Hepatitis B Serology
Test | Result |
HBsAg | Positive |
Anti-HBc IgM | Positive |
Anti-HBc Total | Positive |
HBeAg | Positive |
Anti-HBs | Negative |
HBV DNA | Detectable |
The serological pattern was consistent with acute Hepatitis B infection.
Diagnosis
– Acute Hepatitis B infection
The diagnosis was supported by:
- Acute hepatitis with markedly elevated transaminases
- Positive HBsAg
- Positive anti-HBc IgM
- Positive HBV DNA
- Compatible clinical presentation
Patient Risk Status
The patient was classified as having moderate clinical risk at presentation, with no evidence of acute liver failure.
Favourable Features
- Haemodynamically stable
- INR 1.1
- No encephalopathy
- No significant bleeding
- No ascites
- Preserved renal function
- No evidence of chronic liver disease
Risk Factors Requiring Assessment
- High HBV DNA level
- HBeAg positivity
- Alcohol consumption
- Possible exposure to infected blood or body fluids
- Unknown vaccination status
The patient required ongoing follow-up to determine whether the infection would clear spontaneously or progress to chronic Hepatitis B infection.
Differential Diagnosis
The differential diagnosis included:
- Hepatitis A
- Hepatitis B
- Hepatitis C
- Hepatitis E
- Drug-induced liver injury
- Autoimmune hepatitis
- Alcohol-associated hepatitis
Therapeutic Intervention
Management focused on supportive care, regular monitoring and preventing further liver injury while assessing the patient’s recovery.
Supportive Management
For uncomplicated acute Hepatitis B, the patient was advised to:
- Maintain adequate hydration
- Follow a balanced diet
- Avoid alcohol
- Avoid unnecessary hepatotoxic medications
- Monitor liver function and coagulation profile
- Watch for worsening jaundice or signs of hepatic dysfunction
Routine antiviral therapy is not required for most uncomplicated acute Hepatitis B infections.
Antiviral treatment may be considered in severe or fulminant acute Hepatitis B under specialist guidance.
Monitoring
The patient was followed with regular assessment of:
- Bilirubin
- ALT and AST
- INR and PT
- Albumin
- Creatinine
- Clinical assessment for encephalopathy
- HBsAg and other HBV markers over time
Important Follow-Up Question
What happens if HBsAg remains positive for more than six months?
Persistence of HBsAg for six months or longer indicates chronic Hepatitis B infection and requires assessment for:
- HBV DNA level
- ALT
- HBeAg and anti-HBe status
- Liver fibrosis
- Cirrhosis
- Hepatocellular carcinoma risk
Prevention and Contact Management
The patient received counselling on preventing transmission to others.
Important preventive measures included:
- Avoid sharing razors or toothbrushes
- Cover open wounds
- Practise safe sex
- Do not donate blood
- Avoid sharing needles or injection equipment
- Ensure household and sexual contacts are tested and vaccinated if susceptible
Follow-Up and Outcome
Over the following weeks, the patient’s jaundice and fatigue gradually improved.
At follow-up, liver enzyme levels showed a progressive decline.
The patient was advised to continue regular follow-up until clearance of HBsAg was documented.
Key Learning Points
- Anti-HBc IgM positivity is an important marker of recent or acute HBV infection.
- HBsAg persisting for six months or longer defines chronic Hepatitis B infection.
- Most immunocompetent adults with acute Hepatitis B recover spontaneously.
- Severe hepatitis should be assessed using INR, encephalopathy, bilirubin and clinical status rather than transaminase levels alone.
- Most uncomplicated acute HBV infections do not require antiviral therapy.
- Sexual and household contacts should be evaluated for HBV and vaccinated if susceptible.
- Patients with chronic HBV require long-term assessment for liver fibrosis and hepatocellular carcinoma risk.
- Hepatitis B vaccination is highly effective in preventing infection.
Discussion
This case highlights the typical presentation of acute Hepatitis B infection with fatigue, jaundice and markedly elevated liver enzymes. The patient’s positive HBsAg, anti-HBc IgM and detectable HBV DNA confirmed an acute infection rather than chronic disease.
Regular monitoring of liver function, coagulation status and HBsAg is essential, as persistence of HBsAg beyond six months indicates chronic Hepatitis B and requires long-term assessment for liver fibrosis and hepatocellular carcinoma risk.
Conclusion
This case demonstrates the importance of recognising early symptoms of acute Hepatitis B and confirming the diagnosis with appropriate serological testing. Supportive care, close follow-up and preventive measures can help reduce complications and limit transmission.
For professional medical guidance, liver health assessment or personalised Hepatitis B care, please contact us to connect with the healthcare team.
Note: This case study is for illustrative and educational purposes only and should not replace professional medical advice. If you have concerns about your health or symptoms suggestive of Hepatitis B, please consult a qualified healthcare provider.
