A 27 year old African American female with a past history of the human papilloma virus, gonorrhea, and chlamydia presented with two weeks of diffuse joint pains. The pain started in her knees and progressed sequentially to include her elbows, shoulders, back, and hips. Her associated symptoms were nausea, fever, and a sallow complexion. She denied any history of intravenous drug use, but did endorse a history of multiple sexual partners in the past. Physical exam was remarkable for a temperature of 38.3 C, scleral icterus, and jaundiced skin; However, there was no cardiac murmur or hepatosplenomegaly. Musculoskeletal exam revealed no joint effusions, warmth, erythma, or tenderness. A pelvic exam was normal with negative gonorrhea and chlamydia testing. Labs demonstrated a normal CBC with differential, and an erythrocyte sedimentation rate was 11; An antinuclear antibody was less than 1:40; Rhuematoid factor, hetrophile antibody, cytomegalovirus (CMV) IgM, and rapid plasma reagin tests were all negative; AST and ALT were elevated at 605 and 1303, respectively; Bilirubin was 3.3, alkaline phosphatase 204, and albumin 3.3. At this point, work up was initiated for acute hepatitis. While hepatitis A and C serologies were negative, hepatitis B surface antigen and anti-hepatitis B core antigen were positive. HIV testing was negative. A diagnosis of acute hepatitis B was made. It was presumed that the aquisition of hepatitis B in this patient was from sexual contact. Over the next 10 days her AST and ALT peaked at 4500 and 5500 respectively, bilirubin at 10, albumin decreased to 2.0, and INR was 1.9. Treatment was supportive in nature including fluids and pain control. At time of discharge her AST and ALT were trending down toward normal levels and her symptoms were resolving. She was educated about transmission of hepatitis B with attention to safe sex practices. IMPLICATIONS/DISCUSSION: Migratory polyarthralgia has a challenging and broad differential diagnosis. Infectious causes are many and include gonorrhea, syphilis, CMV, Epstein-Barr virus, Lyme disease, and bacterial endocarditis. Viral hepatits is a possible but uncommon infectious cause. Inflammatory causes are a major category and include rhuematoid arthritis, systemic lupus erythematosis, scleroderma, and polymyositis. Postinfectious causes include rheumatic fever and Reiter's syndrome. Crystalline diseases namely gout and psuedogout can also cause polyarthralgias. Joint aspiration and analysis is the key to diagnosis, however our patient had no joint effusions. With the advent of vaccination, acute hepatitis B virus (HBV) infection is now much less common in the United States. However, it remains a major global problem, particularly in developing countries. Signs and symptoms include malaise, fatigue, myalgias, anorexia, nausea, vomiting, abdominal pain, fever, and jaundice. Migratory polyarthralgia, particularly with a benign joint examination, constitutes an atypical presentation of acute hepatitis B. The incubation period for HBV is 1 to 6 months. While 30% of patients who acquire HBV present with acute symptoms, the majority of patients remain asymptomatic with anicteric hepatitis. Ninety percent of cases of acute hepatitis B clear infection and resolve symptoms within 6 months. They remain asymptomatic carriers of HBV. This is demonstrated by disappearance of the heptitis B surface antigen and appearance of the hepatitis B surface antibody. Less than 1% of patients develop acute fulminant hepatitis. The potential outcome of this subgroup is poor and therefore close follow up of synthetic function is warranted during the initial period. Approximately 5 to 10% progress to eventually develop symptomatic chronic HBV infection. Sequelae can include cirrhosis, hepatic decompensation, and hepatocellular carcinoma. Diagnosis of acute HBV is confirmed with serology, and quantification can be done with the polymerase chain reaction. Treatment is mainly supportive in nature, and patients should be educated about disease transmission. Antiviral therapy is not currently recommended or approved for the treatment of acute HBV.