A 34 year old lady comes to your office for generalized malaise. You have examined her and taken a good history.

Nothing abnormal strikes out during the examination. Empiric treatment with which of the following drugs is most likely going to be helpful?

B12 injection

Levothyroxine

Fluoxetine

Testosterone injection.

Phenelzine

The answer is Fluoxetine.. One must know that 80% of adult cases with fatigue/malaise - suffer from depression. SSRIs are a good first choice. MAOIs (Phenelzine) are almost NEVER used first line.

Further testing of the patient reveals that there is no Viral hepatitis or B12 deficiency. Routine blood work - CBC and chemistries are normal except for ALT and AST wihich are about 3 times the normal limit. ANA is positive. What is the most likely positive serology in this patient?

ASMA positive

Anti dsDNA positive

AMA positive

Anti Sm intibody positive

Australia antigen positive

The answer is ASMA positive. This patient has hepatic involvement due to Lupus.

Explanation:

Typically presents with elevated transaminases. Presenting symptoms vary greatly. Lab confirmation includes ANA+ and ASMA+ in type 1 autoimmune hepatitis (>90 % of cases).