Abstract
A 66-year-old Somalian man, who had migrated to the USA 2 years previously, presented to us in September, 2005, with a 1-year history of substantial weight loss and intractable itching. Examination was normal except for mild icterus and scar marks on his wrists and abdomen, with mild stigmata of chronic liver disease. Laboratory test results were indicative of abnormal liver function (aspartate aminotransferase 129 IU/L; alanine aminotransferase 103 IU/L; albumin 30 g/L; and INR 1·3). Further test results showed presence of hepatitis A IgG antibody, hepatitis B IgG antibody, hepatitis C antibody, hepatitis C virus RNA, and a high α-fetoprotein concentration. An HIV test was negative. CT of the abdomen showed an ill-defined mass measuring 2·8 cm in the right lobe of liver near the junction of right hepatic vein and middle hepatic vein (figure). The possibility of hepatocellular carcinoma secondary to cirrhosis from hepatitis C was considered. However, the patient did not have usual risk factors for hepatitis C (no history of blood transfusion, intravenous drug abuse, haemodialysis, sexual promiscuity, or tattooing).
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