MRCP2-2048

MRCP2-2048

A 55-year-old male with chronic hepatitis B infection presents to the Emergency Department with increasing confusion. His wife states that his specialist has not started him on antivirals yet. He was diagnosed eight months ago. His past medical history includes tuberculosis that has been successfully treated 12 years ago.

His wife stated also that he slept more than usual in the last week and he was more lethargic. On examination the patient was confused, disoriented with a yellowish discoloration of his eyes. There is moderate peripheral oedema and moderate ascites with no signs of hepatomegaly.

Blood investigations were as follows:

Hb 102 g/l
Platelets 250 * 109/l
WBC 9.5 * 109/l
Bilirubin 42 µmol/l
ALP 135 u/l
ALT 370 u/l
γGT 70 u/l
Albumin 32 g/l
α-fetoprotein 15 kU/l

What is the most likely cause of this presentation?