A 45-Year-Old Woman Comes to the Office Due to Cough

question 1434

Multiple Choice

A 45-year-old woman comes to the office due to cough with hemoptysis, night sweats, and subjective fever.  A chest radiograph demonstrates right upper lobe cavity that is consistent with a diagnosis of pulmonary tuberculosis. Sputum staining for acid-fast bacteria is positive.  She is begun on a regimen that includes isoniazid, rifampin, ethambutol, and pyrazinamide.  The patient has a history of alcohol use disorder.  She has taken oral contraceptive pills for the past 5 years.  Two months later when she returns for follow-up examination, her sputum is clear of acid-fast bacilli.  However, she now has fatigue, malaise, and nausea that began approximately 10 days ago.  Physical examination reveals icteric sclerae and tender hepatomegaly.  Laboratory results are as follows: Liver studies
Coagulation studies
Hepatitis panel
Liver biopsy demonstrates panlobular mononuclear infiltration and hepatic cell necrosis.  Which of the following is the most likely diagnosis?

• A)Acute alcoholic hepatitis
• B)Hepatitis secondary to oral contraceptive usage
• C)Hepatitis secondary to isoniazid usage
• D)Autoimmune hepatitis
• E)Tuberculous hepatitis

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