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    HCV Infection with Palpable Purpura - Patient Case of the Week

    HCV Infection with Palpable Purpura - Clinical Patient Case of the Week

    Try this free Disorders of the Liver Case Q&A courtesy of Med-Challenger.

    This HCV infection case comes from our ABEM Emergency Medicine Review.

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    Try this case and test your knowledge of HCV infection.

    A 40-year-old woman with a history of illicit intravenous drug abuse and hepatitis C virus (HCV) infection presents with a skin rash and arthritis affecting her hands and elbows. She also complains of severe weakness and fatigue. She has had long-term elevated transaminase levels, but she has declined treatment for fear of potential adverse events.

    Physical examination reveals palpable purpura over her extremities (see Figure), swollen and tender joints in the elbows and hands, and a diminished sensation with a "stocking and glove" distribution in her extremities.

    Disorders of the Liver Case - HCV Infection with Palpable Purpura - cryoglobulinemic vasculitis
    Her creatinine level is 2.3 mg/dL, and urinalysis reveals microscopic hematuria. Her transaminase levels are elevated in the range of 100 IU/L. Rheumatoid factor is positive. C4 complement is low. (For a list of normal ranges of these laboratory values, click here .)

    Question:

    Which of the following tests will confirm the diagnosis?

    Answer Options:

    serum cryoglobulin testing

    liver biopsy

    kidney biopsy

    electromyography with nerve conduction studies

     

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