Jaundice and Arthralgia

🗒️ Question

A 23 year old woman is diagnosed with rubella during her first trimester of pregnancy. She is advised to take supportive treatment including antipyretics for fever and analgesics for arthralgia. She returns to her GP after three days reporting abdominal pain, dark urine and yellowing of her skin.

On examination, she appears jaundiced with mild right upper quadrant tenderness. There is no hepatosplenomegaly.

Investigations

• Bilirubin: 78 μmol/L (3–17)

• ALT: 120 IU/L (0–40)

• ALP: 160 IU/L (35–104)

What is the most likely cause of her symptoms?

(A) Acute hepatitis from rubella infection

(B) Haemolytic anaemia

(C) Idiosyncratic reaction to paracetamol

(D) Secondary infection

(E) Drug-induced hepatitis from non-steroidal anti-inflammatory drugs