The need for liver biopsy in a patient with acute HCV infection

Background: A 45-year-old white female was admitted to hospital with a 1-week history of right upper quadrant abdominal pain, progressive tiredness and jaundice. Physical examination confirmed jaundice and revealed mild epigastric tenderness. Laboratory test results revealed an extremely elevated alanine aminotransferase concentration, a high bilirubin concentration, the presence of HCV RNA, and a significantly elevated antinuclear antibody titer. Investigations: History and physical examination, laboratory investigations (including complete blood counts, liver function tests, electrolyte analysis, serological and genetic tests), Doppler ultrasound and CT scan of the abdomen, and liver biopsy. Diagnosis: Acute infection with HCV genotype 1a. Management: Supportive care, which included monitoring vital signs and laboratory test results, and management of acute symptoms.