Patients presenting with acute or subacute hepatic injury require a broad differential diagnosis that incorporates demographics, comorbidities, medication history, and specific laboratory patterns. Match each patient's clinical presentation to the most appropriate initial diagnosis on the differential.
- A 28-year-old primigravida at 34 weeks gestation presents with right upper quadrant pain. Labs show a platelet count of , hemoglobin of with schistocytes, and an AST of .HELLP syndrome
- A 32-year-old woman with Hashimoto thyroiditis develops fatigue. Labs reveal an AST of , ALT of , total bilirubin of , and a positive anti-smooth muscle antibody.Autoimmune hepatitis
- A 22-year-old man presents with a new-onset resting tremor, dysarthria, and mild jaundice. Labs show an AST of , ALT of , and a severely depressed serum alkaline phosphatase.Wilson disease
- A 45-year-old man develops severe pruritus and jaundice two weeks after completing a course of amoxicillin-clavulanate. Labs show an alkaline phosphatase of , AST of , and total bilirubin of .Drug-induced liver injury
Answer
The correct matches pair the third-trimester pregnant patient with HELLP syndrome, the young woman with positive autoantibodies to Autoimmune hepatitis, the young man with neuropsychiatric findings to Wilson disease, and the patient with recent antibiotic use to Drug-induced liver injury.
Each clinical vignette provides a highly specific pathognomonic clue or laboratory pattern that distinguishes it from other causes of hepatic injury. The pregnant patient has the classic laboratory triad of HELLP; the young woman has markers of autoimmunity; the young man has the neurologic and enzymatic signature of Wilson disease; and the older man has a temporal exposure to a drug known to cause cholestatic injury.
Step-by-Step Solution
Key Concept
Formulating a differential diagnosis for acute and subacute liver injury by recognizing distinct biochemical patterns (hepatocellular vs. cholestatic) and correlating them with patient-specific risk factors.