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Jaundice in primary school pupils
  1. I Stephenson1,
  2. P Monk2,
  3. J Gray2,
  4. H Thuraisingam2
  1. 1Department of Infectious Diseases and Tropical Medicine, Leicester Royal Infirmary, Leicester LE1 5WW, UK
  2. 2Department of Communicable Disease Control and Public Health Medicine, Leicestershire Health, Leicester, UK
  1. Correspondence to:
 Dr Stephenson;
 istephen{at}globalnet.co.uk

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Answers on p 59.

A previously well 10 year old boy was admitted from school with increasing epigastric pain and vomiting. He had a six day history of feeling generally unwell and feverish with loose motions. On examination he was well, pyrexial at 37.6°C and mildly icteric with epigastric tenderness. There was no organomegaly. Investigations included normal full blood count, differential white count, urea, electrolytes, and chest radiography. Liver function was mildly deranged with alanine aminotransferase (ALT) 250 U/l, alkaline phosphatase (ALP) 280 U/l, and bilirubin 67μmol/l. Paul-Bunnell test and hepatitis B surface antigen were negative. A diagnostic test was performed. He improved after 48 hours and was discharged home well.

Ten days later, a teacher from the same school presented to her general practitioner with nausea, vomiting, abdominal pain, and jaundice. On examination she was deeply icteric with no stigmata of chronic liver disease. Investigations revealed a normal full blood count with deranged liver function of ALT 1900 U/l, ALP 180 U/l, and bilirubin 142 μmol/l. Hepatitis B surface antigen and hepatitis C antibody were negative. A diagnostic test was performed.

QUESTIONS

(1) What is the likely and differential diagnosis?

(2) What was the diagnostic test performed?

(3) What are the risk factors for contracting this condition?

(4) What is the management approach to the control of this condition?

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