My husband works with a Mexican guy who has not been able to communicate what’s wrong with him. Here are the symptoms:
He’s yellow
He’s lost 30 lbs in the past few weeks or so
Something is wrong with his throat
He’s in the hospital and may need an operation
I believe he’s contagious, but we’re not sure about that either
What’s wrong with him?
IANAD but maybe he has some sort of liver or kidney issue. Isn’t jaundice some sort of issue along those lines and it makes you yellow skinned?
That’s what I thought, but what’s with the throat? And an operation?
Hell, I dunno. Maybe a secondary infection. But I am TOTALLY NAD. 
Epstein-Barr Hepatitis? That covers the liver and throat and infection, but not the need for surgery.
Sounds liver-related at any rate. Could be fulminant Hepatitis B, I suppose. Hep C usually doesn’t make a person quite that ill in the acute stage. That part comes decades later.
Otherwise, could be obstructive jaundice: Tumor or stone blocking the common bile duct. But that wouldn’t explain the throat stuff.
Or liver failure from other causes. The pancreas could be involved too. Or not.
More data would be helpful.
How about Hepatitis with vasculitis or Barrett’s esophagus, as long as we’re playing? IANA that kind of D.
Lots of things in the Differential. Good points above. Need data.
Cancer’s in the DDx w/ the weight loss. “Something wrong w/ his throat” is too vague. Pain is quite a different symptom from mechanical trouble swallowing, for instance; infection in the first case and cancer in the second as typical first guesses w/ this presentation. Mono (EB virus) along w/ CMV can give you hepatitis so you turn yellow, plus throat pain. Not so much weight loss ordinarily.
My guess is cancer. The “may need an operation” suggests he might be a candidate for some type of pallliative surgery. Stomach, esophageal, pancreatic, biliary and diffuse mets all in the diff dx. Very few cancers presenting with biliary obstruction (as a cause of turning yellow) are curable w/ surgery.
When a newly yellow guy comes in the first decision point is if the liver cells are diffusely insulted (hepatitis; poisoning) or if there is a blockage external to the liver (gallstones; assorted cancers…)
End-stage liver disease with esophageal varices and GI bleeding? He could be getting endoscopy or a TIPSS, or a surgical portosystemic shunt, or a liver transplant.
Metastatic liver or pancreatic cancer, cirrhosis with esophageal varices, fulminant hepatitis… a few possibilities.
How old is the fellow? Is he known to be a drinker at all? Did it strike out of the blue, or did the fellow seem to half expect he’d fall ill?
Oesophageal cancer with liver mets?
Or maybe he’s trying to say that the surgery will involve going down his throat, in which case it could be an ERCP (endoscopic retrograde cholangio-pancreatography) to investigate/treat his obstructive jaundice.
These are all very interesting diagnoses. The Hep thing makes sense as far as the contagious part goes, though that isn’t transmitted by coughing, is it? I’m thinking body fluids.
My first thought was Hepititis because of the yellow/contagious. I guess if a carrier coughed in another persons face maybe I’m just not sure if hep is transferred through saliva, anyone know? Could he maybe have TB and a liver problem as well? Does TB in fact ever cause jaundice? The surgery part throws me though. Poor guy, sounds really ill…
Only Hepatitis A is easily contracted (though not by coughing - fecal bacteria ends up being taken into the mouth of the infected-to-be), and is typically transmitted through food prepared by an infected person who is not adequately washing up, that kind of thing. (Well, OK, there’s apparently HepE which is similar, but that’s more common in the Indian subcontinent it seems.) The other infectious versions seem to require transmission via blood.
Not just blood, body fluids in general, so modes of transmission for viral Hepatitis include sexual contact (rare for Hep C). Hep B can be contracted in utero, during birth or via breast milk.
Hep B is the leading cause of liver cancer worldwide as infection is endemic in some parts of the world.
NOT rare. Less common, but not rare. There is one study showing a 0.6% transmission rate per year if monogamy is practiced with a Hep C + partner. But the same study indicates that 6% of those with Hep C got it from sexual transmission. Non-monogamous sexual practices raise the risk quite a bit.
(2002 Hepatitis surveillance, Dept. of H & HS, report # 59, CDC, issued Sept. 2004)
Mr. K’s best friend has hep C and his wife doesn’t. They practice monogamy, so good for her, hep-wise.
D’oh!
Good, but not guaranteed. After a decade of unprotected, monogamous sex, her chance of getting Hep C from him will be 6%. After 100 years of the same, it’ll go up to 60%.
(Granted, other factors may come into play regarding rate of transmission with the passage of time)
It’s been close to 10 years I think. But the funny thing is, he’s virtually asymptomatic. How common is that?