Her history included a rather liberal early adulthood during which she had several different sexual partners, and used nasal and intravenous cocaine for a year. She married a successful young attorney five years ago and gave birth to a healthy daughter two years later. She acknowledges slight fatigue, which she attributes to her busy work and homekeeping schedule. Otherwise, she has always enjoyed excellent health. She uses oral contraceptives and has two or three glasses of wine with dinner, three or four nights a week.
Physical examination is unremarkable.
Further investigation performed by her family physician showed normal results for CBC, INR, albumin, total protein, creatinine and electrolytes, ANA, SMA, and abdominal ultrasound. Repeated measurements of ALT monthly, during the past three months, have shown values ranging from 1.8 to 2.6 times the upper limit of normal. She is now referred for consideration of further investigation and treatment. While awaiting her referral appointment, she has read all of the information she could find on hepatitis C and has drawn up a list of questions she wishes to address. Much accumulated experience with the natural history of HCV has, unfortunately, still not produced a reliable crystal ball.