ABSTRACT
A 55-year-old lady presented to the emergency department complaining of abdominal pain, vomiting and a sore throat. She told of a week-long history of nausea, loss of appetite and intermittent fevers. She stated that her friend had mentioned to her 2 days earlier that she looked ‘a bit yellow’. She described pain in the right upper quadrant of her abdomen, which was dull in nature and radiated to her back. Her past medical history was significant for a hysterectomy 5 years earlier due to uterine carcinoma in situ. She was taking tibolone (a synthetic steroid drug with oestrogenic, androgenic and progestogenic properties used as hormone replacement therapy) and calcium carbonate (750 mg) with vitamin D3 (200 I.U.). She worked at a market stall and reported drinking 5 units of alcohol per week. Within the past fortnight she had ended a long-term relationship with a partner who had an unspecified liver disease and had since had unprotected sexual intercourse with one man, of whom she knew no medical details. She had never injected recreational drugs and had not travelled abroad in recent years.
