Infectious Disease
Case 28: An Elderly Woman with Fever and Right Upper Quadrant Pain
CASE
An 80‐year‐old woman was admitted to your ward with a 1‐week history of malaise, fever and right upper quadrant pain. Over the last year she has experienced upper abdominal discomfort and her appetite has been poor as a result. She is a non‐smoker and drinks 10 units of alcohol per week. There is no recent travel history. On examination she looked unwell and was jaundiced. Her temperature was 38°C, heart rate 103 beats/min and arterial blood pressure 105/70 mmHg. She was tender in the right upper quadrant with a palpable liver edge. She also had a non‐blanching rash on her trunk and upper legs.
The following results are available to you:
Hb 13 g/dL WCC 18 × 109/L Platelets 90 × 109/L CRP 360 mg/L ESR 60 mm/h Na 135 mmol/L K 4.5 mmol/L Urea 8.5 mmol/L Creatinine 170 µmol/L Albumin 28 g/L Bilirubin 25 µmol/L ALT 60 U/L ALP 300 U/L γ‐GT 200 U/L PT 20 s APTT 50 s Fibrinogen 0.5 g/L D‐dimer Elevated
Blood culture: lactose fermenting coliform
Abdominal ultrasound: common bile duct dilatation of 14 mm
QUESTION 1
Your score this session: 0 of 0
Which of the following would not explain the prolonged prothrombin time (PT)?