A 38-year-old male soldier presented to the accident and emergency unit with generalized malaise, yellowing of the eyes, and constipation for 3 months. Laboratory tests (reference range in parentheses) revealed: positive hepatitis B surface antigen; elevated hepatitis B viral load of 14,023,079; alpha-fetoprotein levels of 156,660 ng/ml (0–7); direct serum bilirubin of 56.90 mmol/l (0–3.4); total serum bilirubin of 77.90 mmol/l (0–21); gamma GT of 458 u/I (0–60); alkaline phosphatase of 385 u/I (30–120); aspartate aminotransferase of 285 u/I (0–50); and alanine aminotransferase of 120 u/I (0– 50). Hepatitis C antibody and HIV I and II ELISA tests were negative
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