HBsag escape mutants???

[ahmad00001]

Around 4 years i had a needle injury while i was working in a hospital in Russia i would have not remembered it normally but two months following the injury i been having this right upper quadrant pain and it was shifting between heaviness and local pain it continues for minutes and then it goes away also ever since then i had a soft stool with foul smell no matter what i eat the stool comes out soft I'm not even sure if its a steatorrhea and a little itching and these has been the only signs and symptoms i have been experiencing for the last 4 years normally i would have diagnosed myself with chronic hepatitis except the blood tests never supported any diagnosis basically i did almost all the tests available the first ultrasound i did the was about few months after the exposure and the specialist says i have a portal hypertension it measured 14 mmhg but when i did an ultrasound a month later it was normal, for a 2 years period i was doing the same tests these include CBC.LFT,KFT,urinalysis and ultra sound all within normal range,HBSag and Anti HCV negative i repeated these tests pretty much every six months and they came back to be normal.
so i went on my own and tested for PCR HBV DNA quantitative and qualitative and it was negative i had no choice but give up at that point because every doctor i asked said its just in your head so ignored it till the last two months it has been about 4 years itching became the most bothersome symptom to me it intensified so i had to go to see a GI specialist which quiet frankly I'm sure he knows whats he is doing judging by the blood tests he ordered basically he ordered CBC,LFT,KFT,ESR, thyroid function test, lipid profile,H.pylori antibodies,CA19.9
CA125,CA15.3,and alpha fetoprotein despite not being convinced i did test for all of them and they came back normal.

so i had to see again another GI specialist this one recommended an upper endoscopy i went with it and he took a biopsy from my duodenum and ordered anti-tissue transglutaminase IGA,anti Gliadin IGG
and LFT and ultrasound long story short the the only thing appeared abnormal was LFT: AST, and ALT interestingly enough i did the same test again 7 days later and AST,ALT were normal.
i really have no idea whats going on further more not only the pain and itching are so bothersome but i feel like a dumb doctor because i can't really figure out whats going on with me i would really appreciate all the help i can get
any recommendations please

[ahmad00001]

I'm not sure how he measured my portal vein pressure to tell you the truth there was a GI professor who told me that it is within normal range but the guy who did the ultrasound insisted that its not and i never took him seriously since i researched it myself i was still a medical student back at that time anyway to get to your questions
basically every time i did an U/S it was abdominal U/S no abnormality has ever been noted i did that many times in different countries with different people nothing ever came out as abnormal all sizes are within normal ranges and normal echogenicity ..ect regrading the LFT it always included
total bilirubin and direct
albumin
total protein
AST
ALT
Gamma GT
ALP
all of these were normal on multiple occasions
i never did INR, Prothrombin time,bleeding time,IgG,IgA so i dont know
no reduction in platelets either

there could be another cause of itching which is the failure of the liver to clear out the toxins but then again that would only be after the liver has been significantly damaged and i felt the itching right from the beginning there is no way whatever i got was able to manage to damage my liver that quickly not to mention that i don't drink at all, and the symptoms from the beginning were mild so if it is indeed an infection it didn't trigger much of an immune response

i do agree with you at the this point the only way to rule out a liver disease is a liver biopsy but in reality with all of these tests coming out normal no specialist would a do a liver biopsy i mean its the usual stuff they will tell you there isn't a single indication for a liver biopsy. and quiet frankly they are right and thats whats bothering me actually even with my consent i have spoken with 3 specialists already none of them agreed to do a liver biopsy!!  i know what do you wanna say its more like a dead end.  

[fntn]

Difficult diagnosis for sure. How did they measure your HVPG, directly or via the spleen/liver volume correlation? 14 mmHg is within the portal hypertension range. I've measured mine via the volume correlation and have been between 16 and 17 mmHg every time. My spleen is enlarged accordingly. I mention this since your spleen should be enlarged as well, along with a reduction in platelet count.

Also, given the usually normal LFT and IGG/IGA, a liver biopsy maybe your only option, if a liver disease is still suspected, imaging will not be able to provide the needed histopathology for a proper diagnosis.

How are your Albumin and Globulin numbers? Is your INR (prothrombin time) normal as well? Itching is caused by severe cholestasis, and this will be detected via ALP and Bilirubin blood levels, how are yours?

[ahmad00001]

Note i was not vaccinated against hepatitis b prior to my exposure
and I'm 27 years male