A 28-year-old man presents with acute jaundice and malaise. Laboratory studies show total bilirubin 12 mg/dL (direct 8.5), ALT 2200 IU/L, AST 1800 IU/L, ALP 120 IU/L, INR 1.2. Serology: HBsAg positive, anti-HBc IgM positive, HBeAg positive, anti-HAV negative, anti-HCV negative. Which is the most likely outcome?

• A Progression to chronic hepatitis B infection
• B Fulminant hepatic failure requiring transplant
• C Development of hepatocellular carcinoma within 5 years
• D Complete resolution with clearance of HBsAg ✓

Explanation

This patient has acute hepatitis B (HBsAg positive, anti-HBc IgM positive). In immunocompetent adults, over 95% of acute hepatitis B infections resolve completely with HBsAg clearance and development of anti-HBs. Chronicity develops in less than 5% of adult-acquired infections (compared to >90% in perinatal infection). Fulminant hepatic failure occurs in less than 1%. HCC develops over decades in chronic infection, not acute infection. The young age and immunocompetent status favor resolution.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.