Cases Flashcards
(3 cards)
- During directly acting antiviral (DAA) therapy of chronic hepatitis C patients
with negative HBsAg & positive anti-HBc, they should be:
A) Given Entecavir as a prophylactic measure.
B) Given Pegylated interferon for 24 months.
C) Given Tenofovir once ALT is elevated.
D) Monitored for HBV reactivation in case of ALT elevation.
E) Tested for HDV-Ab in case of ALT elevation.
D
A 55-year-old heavy smoker accountant came to you in the outpatient clinic with
marked anxiety. He gave a history of chronic hepatitis C and told that he received a
12- week course of combined sofosbuvir and daclatasavir, finished about 9 months
ago. He did not do follow up investigations until few days ago and was astonished
with the still present moderate viraemia. He is diabetic for 15 years, controlled on
glimipride 6 mg/day and metformin 1500 mg/day. He is normotensive and his body
mass index is 40. His investigations reveal normal CBC and liver profile tests with
serum alpha fetoprotein = 9 ng/ml. Elevated serum creatinine (1.6 mg/dl) and
glucose (250 mg/dl), with normal cholesterol. Abdominal ultrasonography revealed
coarse average sized liver with mild splenomegaly and bilateral grade I nephropathy.
A) What is your advice for him?
1-Reassurance and Education
2-Control Comorbidities:
Dm,wt, monitor renal function,stop smoking
3-Further Investigations:
*HCV genotype and resistance-associated substitutions (RAS) testing if possible, to guide retreatment.
*HCV RNA viral load (quantitative PCR).
*Fibroscan or elastography to assess liver fibrosis more precisely.
B) What are the suitable treatment regimen(s) for this patient?
متنساش GP
Glecaprevir + Pibrentasvir (Mavyret) for 12–16 weeks
42-year-old diabetic female presents for evaluation of a painful skin
rash. She has chronic hepatitis C and she is asymptomatic from that
standpoint. Skin exam reveals a small, raised, reddish-purple rash on the
extensor surface of the lower extremities bilaterally. Laboratory studies reveal
hemoglobin 12.6 g/dL, platelets 140,000, bilirubin 2.2 mg/dL, AST 83 IU/L,
ALT 96 IU/L, alkaline phosphatase 185 IU/L, INR 1.4, low serum complement
level, and positive rheumatoid factor.The best management option for her skin
rash is:
A) Azathioprine.
B) HCV treatment.
C) Systemic steroids.
D) Tacrolimus.
E) Topical steroids.
HCV treatment
