Hepatitis B differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2], Sara Mehrsefat, M.D. [3]

Overview

Hepatitis B must be differentiated from other diseases that cause fever, nausea, vomiting, jaundice, hepatomegaly, icteric sclera, elevated ALT, and elevated AST, such as other types of viral hepatitis, alcoholic hepatitis, and autoimmune hepatitis.

Differentiating Hepatitis B from other Diseases

The table below summarizes the findings that differentiate hepatitis B from other conditions that cause fever, nausea, vomiting, jaundice, hepatomegaly, and icteric sclera.

Disease	Findings
Viral Hepatitis A	Abrupt onset of prodromal symptoms Detectable serum immunoglobulin M (IgM) anti-HAV antibodies Hepatitis, caused by the hepatitis A virus, produces a self-limited disease
Viral Hepatitis C	Acute hepatitis with possible recent exposure to HCV (needle-stick) Symptoms are similar to the ones of hepatitis B, however, hepatitis C can cause acute and/or chronic hepatitis Serologic testing will help differentiate these two conditions Detectable HCV RNA by PCR and anti-HCV antibody testing by enzyme-linked immunosorbent assay (ELISA)
Viral Hepatitis D	Symptoms are similar to the ones of hepatitis B, however, hepatitis D is a serious liver disease caused by infection with the Hepatitis D virus Only occurs among people who are infected with the hepatitis B virus (HBV) May complicate into cirrhosis and hepatocellular carcinoma. Serologic testing will help differentiate these two conditions Detectable IgM anti-HBc with Serum HDAg (enzyme-linked (EIA) or radioimmunoassays (RIA))
Viral Hepatitis E	Symptoms are similar to the ones of hepatitis B, however, hepatitis E may complicate into chronic hepatitis and liver failure in rare cases Detectable IgM antibodies to HEV or HEV in serum or stool by polymerase chain reaction (PCR)
Alcoholic Hepatitis	Symptoms are similar to the ones of hepatitis B, however, alcoholic hepatitis is related to the excessive use of alcohol Often leads to cirrhosis and liver failure Moderately elevated aminotransferases (typically <300 int. unit/mL) ALT<AST in alcoholic hepatitis (inverse from viral hepatitis, which is ALT>AST) Elevated serum bilirubin (>5 mg/dL), elevated INR, and possible leukocytosis
Autoimmune Hepatitis	Autoimmune hepatitis occurs when the body's immune system attacks the hepatocytes It often affects young females and may present with signs of acute hepatitis or chronic liver disease Autoimmune hepatitis has a fluctuating nature It may be asymptomatic or at the far end of the spectrum, may present with acute liver failure with jaundice, elevated PT, and aminotransferase values >1000 U/L