A 73 y/o Male with Jaundice and Fatigue
Initial Presentation:

A 73 year-old male from the Netherlands with history of diabetes mellitus, presented with 2 weeks of fatigue and dark urine. His vital signs were within normal limits and his physical examination was remarkable for jaundice.

Laboratory investigations showed aspartate aminotransferase (AST) levels of 4,700 IU/ml, alanine aminotransferase (ALT) of 5,600 IU/ml, total bilirubin of 15 mg/dl, alkaline phosphatase of 149 IU/ml, INR of 1.2, and ferritin level of 19,000 ng/ml. Complete blood count and chemistry panels were normal. The patient denied taking new medications, over-the-counter products or ingesting mushrooms. He denied use of alcohol, cigarettes or illicit drugs. He had no history of recent travel and no close contacts reported recent illnesses. Serologies for Hepatitis B and C were negative.
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