Viral serology and liver chemistry confirmed acute coinfection with HBV and HCV (Figure 1 and Table 1). A complete blood count, electrolyte levels and tests of renal and liver synthetic function were normal. Screening tests for hemochromatosis, Wilson’s disease, alpha-1-antitrypsin deficiency and autoimmune disease were negative. An abdominal ultrasound was normal.
By December 2003, he was completely asymptomatic, without any treatment, and all liver chemistry had returned to normal. Repeat testing in February and September 2004 confirmed clearance of both HBV and HCV. ventolin inhalers
Figure I) lime course of patients liver chemistry and serology. AL1 Alanine aminotransferase; AP Alkaline phosphatase; Tbili Total bilirubin

TABLE 1 Time course of patient’s liver chemistry and serology

Sept 12, 2003 Sept 18, 2003 Sept 30, October 17, February 2003 2003 2004 Sept
HBsAg +
Anti-HBs + +
Anti-HBc* +
Anti-HBe + +
HBV DNAt 18,400 copies/mL –
Anti-HCV IND +

*Total in September (Sept) 2003, and total and immunoglobulin M in Sept 2004; fHepatitis B virus (HBV) DNA (Cobas Amplicor, Roche Diagnostics, USA) (Abbott 3rd-generation enzyme immunoassay). Anti-HBc Hepatitis B core antibody; Anti-HBe Hepatitis B e antibody; Anti-HBs Hepatitis B surface antibody Anti-HCV Hepatitis C virus antibody; HBeAg Hepatitis B e antigen; HBsAg Hepatitis B surface antigen; IND Indeterminate; ULN Upper limit normal; – Negative; + Positive