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Jaundice, fever and anaemia: when to avoid the cold
  1. Sarah Al-Shakhshir1,
  2. Ayman Bannaga1,
  3. Israa Kaddam2,
  4. Owen Cain3,
  5. Debashis Haldar1,
  6. Matthew James Armstrong1
  1. 1 Department of Hepatology and Liver Transplantation, Queen Elizabeth Hospital Birmingham, Birmingham, UK
  2. 2 Department of Haematology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
  3. 3 Department of Pathology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
  1. Correspondence to Dr Ayman Bannaga, Department of Hepatology and Liver Transplantation, Queen Elizabeth Hospital Birmingham, Birmingham B15 2GW, UK; aymanbannaga{at}

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Clinical presentation

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 …

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  • 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.