Autoimmune Hepatitis in a 20-Year-Old African American Man

作者：Samuel Bensson^*; Fioravanti Gloria; Polimera Hyma; Mayer Amanda; Dorville Fabio; Little Eric

来源：Laboratory Medicine, 2014, 45(2): 161-171.

DOI：10.1309/LMAG0DI6EE4NYCYN

• autoimmune
• liver cirrhosis
• pancytopenia
• hepatosplenomegaly

Patient: A 20-year-old African American man. %26lt;br%26gt;Current Chief Complaint: Bilateral scrotal swelling. %26lt;br%26gt;History of the Present Illness: The patient had experienced painless swelling of his scrotum for the past 2 years. At the time of clinical examination, any movement caused scrotal discomfort; he described experiencing a pulsing dull ache while in a standing position that resolved itself when he lay down. The patient was lethargic and easily fatigued; he experienced dyspnea on exertion. He reported no chest pain, difficulty in breathing, or night sweats. He had unintentionally lost 15 pounds during the past 10 months. He had-experienced no changes in his bowel or urinary habits and no change in his appetite. %26lt;br%26gt;Drug Allergies: No known drug allergies. %26lt;br%26gt;Current Medications: None. %26lt;br%26gt;Family History: The patient%26apos;s father had a history of liver disease; no diagnostic work-up was performed on the father. %26lt;br%26gt;Social History: The patient was a college student; he was single; had no history of tobacco, alcohol, or intravenous drug use, and he was not sexually active. There was no history of recent travel or contact sports. %26lt;br%26gt;Physical Exam %26lt;br%26gt;Vital-Signs: Blood pressure, 95/77 mm/Hg; temperature, 36.8 degrees C; weight, 72.6 kg; body mass index (calculated as the weight in kilograms divided by height in meters squared), 29; respiratory rate, 16 breaths/minute; pulse, 64 beats/minute. %26lt;br%26gt;General: In no acute distress. %26lt;br%26gt;Head, Eyes, Ears, Nose, and Throat: No enlarged lymph nodes and no scleral icterius. %26lt;br%26gt;Neck: No jugular venous distension, thyroid normal, no bruits, and no adenopathic manifestations. %26lt;br%26gt;Breast: Bilateral gynecomastia without tenderness. %26lt;br%26gt;Respiratory: Good air entry, clear to auscultation with dullness to percussion of the lower third of the right lung, no crepitation or crackles. %26lt;br%26gt;Cardiovascular: Regular heart rate; normal S1 and S2; no murmurs, gallops, clicks, or rubs. %26lt;br%26gt;Gastrointestinal: Soft, nontender, normal bowel sounds; mild distension; no shifting dullness; hepatosplenomegaly noted. %26lt;br%26gt;Extremities: No pitting edema or clubbing. %26lt;br%26gt;Genitourinary: Enlarged scrotum, negative Prehn sign, scrotal transillumination did not reveal a dense mass, no change in skin color, no penile discharge.

• 出版日期2014