A 24-year-old female was admitted to our hospital with malaise and jaundice as chief complaints. Ten days before hospitalization, the patient experienced nausea, vomiting, anorexia, malaise, and myalgia. One week after the onset of symptoms, she experienced fever, chills, and yellow-brown stools and developed dark urine, and jaundice became more severe. Throughout the course of the illness, the patient did not experience headaches, photophobia, pharyngitis, or coryza symptoms. Moreover, the patient did not report any weight loss, abdominal pain, changes in smell or taste, or itching.
The individual's lips were tattooed two months before admission. Furthermore, twenty days before admission, the patient traveled to Mashhad and reported acute nausea and vomiting that lasted three days. The patient had no history of drug or substance abuse, homelessness, multiple sexual partners, incarceration, or previous viral hepatitis infections; she tested negative for HBV and HIV infection 11 months before admission. The patient's immunization was carried out according to the national vaccination protocol, but the patient was not vaccinated against hepatitis A and B.
On physical examination, the vital signs were normal, scleral were icterus, and general jaundice was notable. The abdominal examination was negative for hepatosplenomegaly, asterixis, cutaneous stigmata, adenopathy, and edema. Due to the patient's condition and the risk of disease transmission, she was admitted to the isolation room.
Significant leucocytosis, anemia, aspartate aminotransferase (AST) level elevated to 2600 U/L, alanine aminotransferase (ALT) level elevated to 3590 U/L, alkaline phosphatase (ALP): 432 U/L, total bilirubin (TB): 15.8 mg/dL, and direct bilirubin (DB): 9 mg/dL were observed following laboratory evaluation. Her hepatitis test results were positive for HAV IgM, negative for HAV IgG, positive for HBV core IgM, and positive for HBsAg and HBeAg. However, human immunodeficiency virus- (HIV-), HDV-, and HCV-antibody testing were negative. The total protein and albumin levels in the serum were 5.7 g/dl and 3.2 g/dl, respectively. The partial thromboplastin time (PTT) and prothrombin time (PT) measurements were 41 and 18 seconds, respectively, and the international normalized ratio (INR) was 1.51 (Table 1).
Abdominal ultrasound was reported normal, with no biliary dilatation and extrahepatic obstruction. The coinfection of HBV and HAV was confirmed based on clinical examination and laboratory results. Due to her severe condition, tenofovir was administered as a supportive and antiviral treatment throughout therapy. After three days of treatment, her laboratory tests and symptoms began to improve, and within one week, she was discharged and advised to return for follow-up care. After two weeks of treatment with antiviral medication (tenofovir), her laboratory test was within normal range, and her clinical symptoms were completely resolved. Therefore, we discontinued antiviral treatment, and within one month of follow-up, the patient still did not have any clinical symptoms, and her laboratory tests were still within the normal range (Table 1).