A 21-year-old man is evaluated for a 2-week history of fatigue and a 1-week history of right upper quadrant discomfort and dark urine. He drinks three alcoholic beverages per day and uses injection drugs. There is no personal or family history of liver disease or hepatocellular carcinoma.
On physical examination, temperature is 38.0 °C (100.4 °F), blood pressure is 120/68 mm Hg, pulse rate is 112/min, and respiration rate is 20/min. He is alert and oriented. Needle marks are noted on the arms. There is no asterixis. Scleral icterus is present. There is right upper quadrant tenderness, and the liver is enlarged, soft, and tender. There is no ascites and no splenomegaly.
INR | 1.2 (normal range, 0.8-1.2) |
Alanine aminotransferase | 1843 U/L |
Aspartate aminotransferase | 1598 U/L |
Total bilirubin | 4.8 mg/dL (82.1 µmol/L) |
Anti–hepatitis A virus IgG antibodies | Positive |
Anti–hepatitis A virus IgM antibodies | Negative |
Hepatitis B surface antigen | Positive |
IgM antibody to hepatitis B core antigen | Positive |
Hepatitis B e antigen | Positive |
IgG antibody to hepatitis B core antigen | Negative |
Hepatitis B surface antibody | Negative |
Antibody to hepatitis B e antigen | Negative |
Hepatitis B virus DNA | 69,000 IU/mL |
Ultrasound of the right upper quadrant reveals an enlarged liver with no masses. The spleen is normal, and there is no ascites.
Which of the following is the most appropriate management?