Acute Hepatitis C: An Unusual Mode of Transmission

Introduction: Chronic hepatitis C infection is one of the most common causes of chronic liver disease, with evidence of infection in nearly 4.1 million individuals in the United States. Acute hepatitis C affects about 17,000 people per year. Here, we present a patient who acquired acute hepatitis C from an unusual mode of transmission. Case: Our patient is a 45-year-old man who was admitted with nausea/vomiting, jaundice, abdominal pain, acholic stools, and scleral icterus for the past three months. These symptoms developed approximately two weeks after he debrided a pustule on his hand with a used insulin needle from a friend with known hepatitis C. Anti-HCV antibodies were positive, and a viral load of 11,413 (4.1 log) copies was noted on RNA quantitative PCR testing. HCV genotyping showed genotype-3 disease. Additional work-up for etiologies of chronic liver disease, included testing for autoimmune hepatitis, Wilson's disease, hemochromatosis, and alpha-1-antitrypsin deficiency, all of which were negative. The patient's hospital course was otherwise unremarkable, and his symptoms and labs improved with symptomatic cares only. The patient's symptoms and pattern of LFT abnormality was most likely due to acute hepatitis C infection rather than chronic disease, given the patient's prior history and identifiable, though unique, exposure prior to onset of symptoms. The patient had spontaneous lab-confirmed clearance of the virus, normalization of his LFTs, and no further symptoms. Discussion: Our patient is unique for several reasons. His postulated mode of transmission was highly unusual, given the type of needle and how it was used. The patient did require surgical debridement of his hand for wound management after using his friend's needle, and thus appears to have used what is ordinarily a subcutaneous needle for deeper penetration. The patient's male sex and genotype-3 disease put him at higher risk of progression from his HCV disease, but the patient was able to spontaneously clear the disease without treatment.