A 16-year-old boy is seen because of malaise, fatigue, and nausea for 2 weeks. His parents think he appears jaundiced. He reports pruritus and mild headaches but denies vomiting, diarrhea, fever, abdominal pain, arthralgias, or bruising, as well as exposure to alcohol or drugs.

His past medical history includes only acne vulgaris, treated with minocycline for more than 2 years, and minor injuries. He denies taking over-the-counter medications. He was at a resort in Mexico 2 weeks ago. He denies any recent insect, tick, or animal bites. His immunization status is current, including hepatitis B vaccination.

On physical examination, he has scleral icterus and appears ill but is in good spirits. All vital signs are normal. The abdominal evaluation reveals a liver edge palpable 1 to 2 cm below the right costal margin, with a total liver span of 8 to 10 cm. There is no palpable spleen or ascites....

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