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A 21-year-old woman presented with a 2-week history of jaundice and fever, without abdominal pain, nausea or vomiting. Her partner was treated with antibiotics for tonsillitis 1 week before her presentation. She had no medical history, drug history and/or recent travel history. She enjoyed horse-riding as a hobby. Physical examination revealed fever of 38.5°C, tachycardia of 107 beats per minute and systolic blood pressure of 110 mm Hg. She had pallor, jaundice and mild hepatosplenomegaly.
Laboratory tests revealed alanine transaminase (ALT) of 392 U/L, alkaline phosphatase (ALP) of 183 U/L, bilirubin of 238 μmol/L (conjugated bilirubin of 193 μmol/L), albumin of 19 g/L and CRP of 26 mg/L, with normal renal function. Full blood count revealed macrocytic anaemia (haemoglobin of 60 g/L and mean corpuscular volume (MCV) of 113 fL). White cell count, platelets …
Correction notice This article has been corrected since it published Online First. Two missing sentences have been added to the end of the second paragraph.
Contributors All authors contributed equally to this manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.