Presentation
RUQ pain, deranged LFTs and increasing inflammatory markers.
Patient Data
The liver has a heterogeneous enhancement pattern; the hepatic veins are not opacified. Portal veins are patent. Periportal edema and fat stranding. Gallbladder wall is mildly thickened.
Horseshoe kidney. Spleen, adrenal glands and pancreas are normal.
Sigmoid diverticular disease without evidence of diverticulitis. Normal appendix. Small bowel is unremarkable. No free gas. Pelvic and right paracolic gutter free fluid. Left fat-containing inguinal hernia.
Moderate sized bilateral pleural effusions.
Case Discussion
This patient's viral screens returned negative, but the patient's liver failure worsened requiring multiple ICU admissions. Liver biopsy demonstrated necrosis in keeping with drug toxicity, with either amoxicillin-clavulanic acid or methamphetamine thought to be the likely cause.
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