A previously healthy 50-year-old woman presented with 3 weeks of fatigue, nausea, dark urine, pruritus, and scleral icterus. She was treated for Graves disease approximately 20 years previously and had no known family history of autoimmune disease. She reported rare alcohol use, no consumption of herbal products, no new medications, and no illicit drug use. She had no known viral exposures, recent vaccinations, or recent travel. On examination, she was jaundiced and had epigastric abdominal discomfort, but no edema or encephalopathy. Results of blood testing for hepatitis A, B, and C and COVID-19 polymerase chain reaction testing were negative. Findings of abdominal ultrasonography with Doppler were normal. Laboratory data are shown in the Table.
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Corresponding Author: Gideon M. Hirschfield, MB, BChir, PhD, Toronto Centre for Liver Disease, Lily and Terry Horner Chair in Autoimmune Liver Disease Research, University of Toronto, 200 Elizabeth St, Toronto, ON M5G 2C4, Canada (firstname.lastname@example.org).
Conflict of Interest Disclosures: Dr Hirschfield reported receiving personal fees for consultancy from Intercept Pharma, Cymabay, Genfit, Roche, Pliant, High Tide, Mirum, and GlaxoSmithKline outside the submitted work. No other disclosures were reported.
Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:
It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.
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