Such diagnostic evaluation of hepatocellular enzyme elevation
is well known to the gastroenterologist. However,
there are some noteworthy diagnoses that masquerade as
DILI. Even though 10,000 new infections occur in the United
States annually, acute hepatitis C is often overlooked because
gastroenterologists are more accustomed to seeing the indolent
chronic phase of infection, and diagnostic test results are
variable in acute infection. Very early in infection, hepatitis C
virus (HCV) antibody can be negative, and HCV RNA testing
may be necessary. Detectable HCV RNA without antibody is
consistent with acute infection. Seroconversion in the following
4 to 12 weeks with or without loss of HCV RNA would be
strong evidence for acute infection, particularly if a recent risk
factor were identified. Ultimately, repeat history taking for
hepatitis C risk factors and retesting of HCV antibody and RNA
in 4 to 12 weeks should be done, but are often forgotten.
Pursuing the diagnosis of acute hepatitis C takes on added
importance as we enter an era of more tolerable and curative
therapies.