Mansour Jennifer, Geha Rabih M, Manesh Reza, Kidambi Trilokesh D, Sisk Anthony, Trujillo Monroy
University of California Los Angeles.
Greater Los Angeles Veterans Affairs Medical Center, California.
Fed Pract. 2025 Jun;42(6):230-234. doi: 10.12788/fp.0593. Epub 2025 Jun 16.
Patients admitted to the hospital from the emergency department are often evaluated with inherent diagnostic biases, particularly when the admitting diagnosis is anchored early. When a patient presents with suspected decompensated cirrhosis, it is important to consider other diagnoses with similar presentations and ensure multiple disease processes are not contributing to the symptoms.
A 64-year-old male without stable housing was admitted for management of newly diagnosed decompensated cirrhosis based on imaging. Additional analysis of laboratory results, imaging, and clinical presentation suggested that the decompensated cirrhosis diagnosis was not proportionate to the severity of the patient's hypoalbuminemia. Additional workup was conducted, and hepatology, nephrology, and infectious disease specialists were consulted. Extensive laboratory workup and a renal biopsy confirmed a diagnosis of compensated cirrhosis and nephrotic syndrome due to early membranoproliferative glomerulonephritis, both secondary to hepatitis C infection.
This case offers important teaching points on nephrotic syndrome and hepatitis C, and highlights the importance of re-evaluating diagnostic assumptions to prevent delays and errors.
从急诊科入院的患者常常会受到固有的诊断偏差影响，尤其是在早期确定入院诊断时。当患者出现疑似失代偿期肝硬化的症状时，重要的是要考虑其他具有相似表现的诊断，并确保多种疾病进程不会导致这些症状。
一名64岁无稳定住所的男性因影像学检查确诊为新发性失代偿期肝硬化而入院。对实验室检查结果、影像学检查及临床表现的进一步分析表明，失代偿期肝硬化的诊断与患者低白蛋白血症的严重程度不相称。于是进行了进一步检查，并咨询了肝病科、肾内科和传染病科专家。广泛的实验室检查及肾活检确诊为代偿期肝硬化和由早期膜增生性肾小球肾炎导致的肾病综合征，二者均继发于丙型肝炎感染。
该病例提供了关于肾病综合征和丙型肝炎的重要教学要点，并强调了重新评估诊断假设以防止延误和错误的重要性。
