63-Year-Old Man With Chronic Hepatitis C Virus Infection and Proteinuria

TLDR: A 63-year-old man presented for evaluation of right-sided abdominal pain of 2 days’ duration, which showed minimally active (grade 1) HCV without fibrosis; a human immunodeficiency virus (HIV) test done at that time yielded negative results.

Abstract: Resident in Internal Medicine, Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, MN (C.O.A., I.J.S.); Adviser to residents and Consultant in Nephrology and Hypertension, Mayo Clinic, Rochester, MN (V.D.G.). A 63-year-old man presented for evaluation of right-sided abdominal pain of 2 days’ duration. He had no fever, chills, nausea, vomiting, poor oral intake, diarrhea, hematemesis, or melena. The pain did not correlate with food intake, and he did not have anorexia. He reported no dysuria, hematuria, recent travel, or herbal supplement or over-the-counter medication use, including any nonsteroidal anti-inflammatory drugs. His medical history was remarkable for chronic hepatitis C virus (HCV) genotype 2b infection, normocytic anemia, cholecystectomy, fatty liver, dyslipidemia, hypertension, and alcohol and intravenous drug abuse. He had undergone liver biopsy 9 years before the current presentation, which showed minimally active (grade 1) HCV without fibrosis; a human immunodeficiency virus (HIV) test done at that time yielded negative results. Recent esophagogastroduodenoscopy performed for evaluation of chronic dyspepsia showed changes consistent with portal hypertensive gastropathy. His medications included simvastatin, amlodipine, and thiamine. At presentation, the patient was hypertensive, alert, and oriented. He had multiple tattoos on his face, abdomen, and arms. Cardiac examination revealed normal heart sounds with no murmurs or elevated jugular venous pressure. His lungs were clear to auscultation. Although his abdomen was not distended, there was tenderness in the epigastrium and right upper and lower quadrants. Neither guarding nor rebound tenderness was noted. Bowel sounds were present, and his extremities were without edema. The remainder of the physical examination findings were unremarkable. Vital signs were as follows: pulse rate, 92 beats/min and regular; blood pressure, 162/113 mm Hg; temperature, 36.8 C; and oxygen saturation, 92% while the patient breathed room air.