A 50-Year-Old Woman With Massive Splenomegaly and Hepatitis C Infection

Author: Howard Hampel, MDSeries Editor: Richard Goodgame, MD


March 13, 2003

Case Presentation

The patient is a 50-year-old-woman who was well until 6 months ago when she began having mild abdominal pain and decreased appetite. The pain was constant, in the left upper quadrant, exacerbated by movement, and relieved somewhat by rest. She had mild, early satiety but developed profound decreased appetite such that she had lost 20 pounds during the previous 6-month period. There was no dysphagia, dyspepsia, nausea, vomiting, altered bowel habits, fever, or night sweats.

The patient used intravenous drugs briefly during her twenties and thirties, but has not used for the last 20 years. She abused alcohol most of her life but stopped drinking entirely 4 years ago. She has a stable family and financial situation. There is no family history of serious illness.

Physical examination showed normal vital signs except for a temperature of 99.6ºF. There were no enlarged lymph nodes or skin lesions. There were no peripheral stigmata of chronic liver disease. The head, ears, eyes, nose, and throat were normal. Cardiac and pulmonary examinations were normal. The spleen was massively enlarged, extending inferiorly to below the level of the umbilicus and easily felt across the midline of the abdomen; it was soft and nontender. The liver span was 10 cm by percussion; the edge was soft and smooth, easily felt 2 cm below the right costal margin in the midclavicular line. The neurologic examination was normal.

Results of routine laboratory studies revealed the following:

Hemoglobin, 10 g/dL
White blood cell count, 13 x 103 cells/mm3
Lymphocytes, 82%
Polymorphonuclear leukocytes, 15%
Platelets, 236 x 103/mm3
Mean corpuscular volume, 91 fL
Total protein, 5.5 g/dL
Albumin 3.1 g/dL
Total bilirubin, 1.1 g/dL
Direct bilirubin, 0.6 g/dL
Alkaline phosphatase, 177 U/L
Alanine aminotransferase (ALT), 111 U/L
Aspartate aminotransferase (AST), 47 U/L
Lactate dehydrogenase (LDH), 304 U/L
Prothrombin time, 12.6 sec

Viral serologies were negative for hepatitis A, hepatitis B, and HIV markers, but were positive for hepatitis C virus (HCV) antibody. HCV RNA was positive by polymerase chain reaction (> 850,000 copies). Serum levels of antinuclear antibody, alpha-1-antitrypsin, ceruloplasmin, alpha-fetoprotein, and lipids, as well as results of iron studies, were normal or negative.


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