The numbers I’ve always read are 0-3% sexual transmission, with the studies noting that sexual transmission couldn’t be confirmed due to other risk factors. I’ve just reviewed this literature for my friend and haven’t seen the study you cite. I’ll look for it when I have a minute. Of course, with the high rate of community acquired cases, there’s apparently something we don’t yet know about HCV transmission.
Pretty common.
But say…we are going to get a follow up on the Mexican guy, aren’t we?
In medical circles the unspoken deal of the mystery case presentation is the revelation of what it really was so those who were right can gloat and those who were way off base can sulk about the quality of the case presentation.
Except for the “possibly contagious” part which I’m dismissing as a red herring, I’m sticking with cancer. Unless the case presentation was bad. 
In which case my misdiagnosis was someone else’s fault.
I shall pump the ol’ man for information, but I really think it’s a case for House. I know the guy went to the doctor, the doctor told him to stay home, and he came back sooner than he was supposed to. The doctor bitched him out and put him into the hospital. But when you ask him, he just points to his throat and says he might need an operation. Even the other Mexicans can’t get a clear answer out of him, so I think he’s probably not understanding exactly what his doctor is saying to him.
I’m dying to know and as soon as I hear something, I’ll let y’all know.
I’m no Doctor, but a couple of other possibilities: Hepatitis, and mononucleosis, though an operation on the throat not a drastic measure there. Second: Tonsillitis, complicated by hepatitis. What type of work does he do, and where? In some parts of Louisiana, adult tonsillitis is a common occurence, probably due to environmental factors. So, there would be an easy surgery recommendation for resolution of that problem.
Again, I’m not a medical professional, but learned a great deal when my sister in Louisiana had a later life tonsillectomy.
OK, I’ll bite.
How about gastric carcinoma with dysphagia from the primary tumor, and jaundice from liver mets (or, I suppose, portal node mets leading to biliary obstruction)?
If it weren’t for the apparent need for an “operation” (which may be a misunderstanding or a red herring anyway), I might go out on a limb and say acute leukemia (with the sore throat due to local infection and the jaundice likely due to hepatic involvement or maybe even from hemolysis). (BTW, I would shoot a student who offered leukemia as the unifying diagnosis - but, here, I’m allowed to use my imagination 
).
Yellow? Maybe a disease starting with “xantho-”
I already covered that. Epstein-Barr hepatitis is mono which involves not only the tonsils, but also the liver.
Most likely cause of that would be Epstein-Barr.
??? Please elaborate. Most tonsillitis is due to infection, mostly Epstein-Barr Virus, Group A Beta Hemolytic Streptococcus, Staphylococcus aureus, or Hemophilus Influenzae. Not environmental factors.
One doesn’t often pull acutely inflamed tonsils out, either.
I’d go with the esophageal varicies from ESLD. Maybe acute-on-chronic liver failure. Explains the throat (bleeding varicies), the jaundice, and the operation (emergent liver transplant). Could be a rapidly progressing HepC complication like bridging fibrosis. Or could be fulminant HepB or HepC, doesn’t really explain the throat thing. Cancer is another good bet.
There is also the possibility that he has some kind of plain-old obstructive jaundice caused by cancer, stone, or inflammation or just cholangitis and the throat thing is just that he had to have upper endoscopy (and it hurt his throat, which often happens).
Digging deeper though, if he is from Mexico, then maybe we can add invasive amebiasis, Q fever, echinococcus, Fasciola, ascariasis… Also autoimmune hepatitis can evolve that quickly.
Dammit, I knew that. I have to stop posting so early in the morning when I’m busy and not thinking clearly yet. Sorry, folks.
Hey thanks!
It only takes a couple very basic tests to find out if it’s a sick liver or external blockage. If it’s external blockage a single CT scan will most times figger it out.
In our ED we’d know within a couple hours what the general problem is; maybe some specialized tests to find out what’s inflaming the liver if it turned out that was the problem.
The pointing to the throat deal could just mean they want to do an Upper GI endoscopy and ERCP (endoscopic retrograde cholangiopancreatography, which is why we use initials) to look at the bile ducts and see if they are blocked (gallstones or various cancers, usually). That might be something that takes a day or two to put on the schedule in some places…
I was also thinking along the lines of hepatic cirrhosis (secondary to such common causes as chronic viral hepatitis, autoimmune hepatitis or drinking) with esophageal varices (which could require surgical intervention to prevent massive bleeding). Marked weight loss over a short term is worrisome for malignancy. Hepatocellular carcinoma typically occurs in the setting of cirrhosis. Often the serum alpha-fetoprotein will be markedly elevated with this type of tumor.
It takes considerable replacement of normal liver by tumor (primary or metastatic) to cause jaundice, so the jaundice itself may well be due to underlying disease of the liver or blockage of bile drainage somewhere along the line (due to benign or malignant causes).
Hope it’s something treatable.
We need the punch line here.
I mean no disrespect, but a number of people seem to have implied (if I’m interpreting their words correctly), that the presence of esophageal varices might be the cause of his apparent throat discomfort. I’ve never, ever seen that and be surprised if it even exists. Varices are either asymptomatic or BLOODY symptomatic ( )
Did I miss something about the guy having “throat discomfort”?
The relevant statements from Kalhoun are “Something is wrong with his throat” and “when you ask him, he just points to his throat and says he might need an operation.” Nothing in that implies dysphagia or pain.
Of course we’re all just guessing at the cause(s) here.
No disrespect meant. 
Jeez…this is almost like being a veternarian! No way to communicate with the patient. I’m still waiting to hear from Mr. K if they got any more info.
Update: Mr. K said the guy has a “thyroid problem” and will be off work for one to six months. Cancer?
I am feeling a little dumb here, so maybe you can help me even though this is off-topic. I understand you to be saying that one is more likely to contract a disese from a partner with a confirmed sexually transmittable disease if you have sexual contact with others who may or may not have sexually transmittable diseases.
Why is your risk of contracting HCV from your partner higher if you sleep with someone else? Certainly, I understand that your overall risk of getting STDs is higher when you have more partners. But does it really lower your resistance in some way, or make it more likely that you’ll contract the disesase you’re continually being exposed to?
Maybe I misunderstood these comments, but this seems to be what you’re saying and what some others infer with their replies. Is it true?
Thyrotoxicosis (superactive thyroid going nuts) can present with jaundice:
http://www.endocrine-abstracts.org/ea/0011/ea0011p123.htm
That would make him a pretty cool case and also give him a good prognosis.
It’s not very common for thyroid cancer to cause jaundice. 1 to 6 month timeline to get his thyroid under control fits, too. Weight loss fits w/ thyroid. Also, there’s no way a typical layperson, esp w/ a language barrier thrown in, would be able to translate the jargon for thyrotoxicosis. “Possible surgery” doesn’t fit. “Contagious” doesn’t fit except in the sense that any newly yellow person might have and infectious hepatitis as a cause until it’s ruled out.
“Not very common”? Are you kidding - it’s EXCEPTIONALLY RARE at best (and, aside from the abstract cited, I’d like to see another reference in English). The fact there’s even an abstract about those two cases only confirms its rarity (btw, there is, at this time, not been a full-length publication arising from the abstract).
Anecdotally, I’ve seen scores of fresh hyperthyroid people. Sometimes the alk phos is up, but I’ve never encountered a significantly elevated bilirubin (NB - the alk phos is from bone, anyway). As you know, the textbooks back me up.
On a statistical basis alone, I’ll say there is NO way his thyroid condition caused the jaundice. If, in fact, he actually does have a thyroid problem (nothing seems well established in this case yet), it’s more likely that whatever caused it has also caused the jaundice (eg. autoimmune diathesis with, say, autoimmune thyroid disease and autoimmune hepatitis or PBC; amiodarone-induced thyroiditis and hepatitis; possibly a viral infection; etc.)
IANAD but just to throw it out there…wouldn’t AIDS or an AIDS/Hep C coinfection explain the throat, liver, wasting and “possible contagion”? I don’t know about the sudden onset, and surgery I guess it wouldn’t explain…but then if there’s a language barrier he might be referring to any kind of invasive procedure. Would also explain why he’s hesitant to give an exact diagnosis clearly.
Wow. Infectious hepatitis can cause thyroid problems? Sheesh.
Well, if I’m not mistaken, Mexican immigrants do have a higher instance of hep, right? That might make sense then.