In 1986, a 38-year-old woman with acute jaundice was diagnosed as having non-A, non-B hepatitis. The history at that time did not reveal any confirmable source or risk factor for the disease. The woman worked as a free-lance journalist and had traveled throughout the world. She had undergone dental work two to three months before the onset of illness. Six months earlier, she had had sexual intercourse with an IV drug abuser. She was not taking any medications, had never been transfused or tattooed, and had never used IV drugs. After the acute icteric event, her liver enzymes did not return to normal. In 1989, she presented to our institution for evaluation of right upper quadrant discomfort and what she thought was an enlarged liver. On physical examination, she did not have stigmata of chronic liver disease: no scleral icterus, palmar erythema, spider angiomata, or Kayser-Fleischer rings. Her abdomen was soft and nontender. Her liver was not palpable or enlarged on percussion. The patient was slender, and the examiner thought that a spleen tip was possibly palpable in the right lateral decubitus position but was not convinced that she had splenomegaly. She had no ascites or peripheral edema. The remainder of her examination was negative.
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