MDcooper
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31-year-old professional bodybuilder presents complaining of 3 weeks of worsening fatigue, low-grade fevers, and myalgias, as well as the gradual onset of jaundice over the past week. He admits to unprotected anal sex 3 months earlier after a championship bodybuilding event. He denies any other homosexual activities. He has no other medical problems and is on no medications. On physical examination, he appears acutely ill, with a temperature of 39.3 C (102.7 F), a blood pressure of 116/60 mm Hg, and a pulse of 114/min. He is deeply icteric and has multiple excoriations over his entire body. His liver edge is smooth and very tender and measures 14 cm in the midclavicular line. There is no shifting dullness, and a spleen tip is palpable 4 cm below the left costal margin. Stool is brown and guaiac negative, and there is no peripheral edema. Which of the following laboratory findings would most likely indicate the worst prognosis?
A. Prothrombin time of 19.6 seconds
B. Aspartate aminotransferase (AST) of 983 U/L
C. Alanine aminotransferase (ALT) of 13,420 U/L
D. Total bilirubin of 27.4 mg/dL
E. White blood cell count of 18,400/mm3
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| prathapdoctor
Forum Elite
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elevated prothrombin time.
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| mazinger
Forum Guru
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agree
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