Acute hepatitis A and recent EBV infection in the setting of suspected post-concussion syndrome
Hospitalized observation status, receiving supportive care and monitoring
Discharged on hospital day 1 as symptoms improved and liver enzymes began to downtrend.
In outpatient follow-up, JC reported resolved nausea and abdominal pain, and his liver enzymes normalized. He continued to exhibit post-concussion syndrome symptoms with ongoing headache and concentration difficulties. His SCAT symptom severity scores ranged from 34-55. Routine concussion management was continued with rest and school adjustments, and he was started on amitriptyline 20mg QHS. He was then lost to follow-up. He presented again 2 months later requesting medical clearance to participate in high school lacrosse. However, still exhibiting mild post-concussion symptoms, he was not cleared to play. He was referred to a formal concussion rehabilitation program, consisting of physical, occupational and speech therapy. JC continues concussion rehab at the time of this submission.
This case highlights the difficulty in management of ongoing concussion symptoms, the non-specific nature of concussion symptoms and the great degree of overlap of these symptoms with other clinical diagnoses. Perhaps more importantly, the case highlights the ever-important concepts of obtaining a detailed history and exam and keeping a broad differential diagnosis.
There are a variety of complex issues that may make management of a case like this difficult. It is important to prioritize issues as these physicians did. The worsening nausea, abdominal pain, and scleral icterus necessitated immediate attention. Once these issues were triaged and managed successfully the patient's stable post concussion symptoms were addressed.
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