Case No 1

19-year old man admitted to hospital due to jaundice which was preceded by vomiting and diarrhea with fever

Medical History

Present Illness: Fell to flooded river when on the river bank his head spinned (was dizzy) on the river bank, he swallowed a little of river water. He vomited later in the evening at home, next day temperature rose to 39 °C, chills without shivering, vomiting and diarrhea continued. Another day fever and vomiting subsided. Diarrhea persisted, treated with Endiaron, Carbo and Santax. The stool improved. 16 days after this accident the patient felt great calf pain, after another 2 days the skin turned to yellow. He stayed afebrile, without vomiting, no diarrhea.

FHx: Parents are healthy, younger brother is healthy too
EHx: Denies the contact with infection, was not abroad
WSHx: Car mechanic
PM/SHx: Recurrent otitis media even with paracentesis, he had chickenpox, no serious illnesses, proper vaccination
Allergies: NKDA
Medications: Not using anything
Abuse: Non-smoker, social drinking of alcohol, drugs not used

Physical Examination

TT 36,5 °C, alert and oriented, cooperating, eutrophic, icterus of skin and sclera. Head: NAD, eyes, ears, nose without any discharge. Throat clear with no erythema., tongue a little drier, with whitish coating. Neck supple with no LAD or masses. Breath sounds, HR 76', heart sounds normal, pulses 2+ equal on both sides. BP 110/60. Abdomen soft, non-tender, non-distended. No masses. No rebound/guarding. Liver palpable 2 cm below costal margin, spleen not palpable. BS+ Extremities: No edema, mild tender to palpation, Homans a plantar sign negative. Meningeal signs negative.

Laboratory examination

Hematologic laboratory:

Biochemical laboratory:

Microbiology laboratory examinations:

Imaging and Other Examinations

Imaging studies:

Electrophysiologic examinations:

Diagnostic Conclusion

Make a diagnosis


Determine for yourself


19-year old male patient admitted to hospital for jaudice. At the beginning elevated liver tests were noted, higher urea, CRP, CK and myoglobin, in the BC thrombocytopenia. Due to the fall into water patient history and swallowing of water there was a suspicion for [------], that has been confirmed [------]. Therefore [------] was prescribed. During therapy subjective problems disappeared, no icterus confirmed, and better laboratory values. Before discharging from the hospital the patient was afebrile, CRP, CK, myoglobin and renal functions were normal, thrombocytes normalized, slight hyperbilirubinemia is persisting. Discharged home in good clinical health condition.


  1. What examination do you recommend to add to give the diagnosis and propose a therapy?
8 Viral hepatitis and liver infection
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