Acute Jaundice in a 16-year-old Boy

摘要

A previously healthy 16-year-old Asian-American boy presents to the emergency department with the acute onset of jaundice and an approximately i week history of dark, tea-colored urine, described by the patient as "almost black," with dysuria. In the previous 3 weeks, he has had progressive fatigue, decreased appetite, dizziness, blurred vision, headaches, and sore throat. His immunizations are up to date. Family history is not contributory. He has no known sick contacts and no recent medications. He endorses unprotected sexual activity but denies illicit drug use, travel, or animal contacts. Physical examination reveals a diffusely jaundiced boy with scleral icterus and a heart rate of 92 beats per minute, respiratory rate of 20 breaths per minute, and blood pressure of 120/70 mm Hg. His lungs are clear, and he has no murmur, pharyngeal erythema or exudate, abdominal tenderness, hepato-splenomegaly, or lymphadenopathy.