An Unusual Cause of Right Upper Quadrant Pain With Abnormal Liver Enzymes

Abstract

Question: A 78-year-old woman presented to the emergency department with 2 weeks of right upper quadrant abdominal pain, fatigue, and weight loss. She described a loss of appetite, but denied fever, chills, or diarrhea. There was no history of prior biliary disease, hepatitis, recent travel, drug use, or new sexual partners. Her history was notable for psoriatic arthritis, which was well-controlled on ustekinumab. The physical examination was remarkable for tenderness in the right upper quadrant without other stigmata of liver disease.