Greetings of the day ! Mrs Radha (name changed) a 28 year old female was admitted with a history of recurrent vomiting and Jaundice of one day duration to our hospital. She had no history of viral prodrome , fever or any offending drug intake .She was conscious oriented, and had mild icterus . Her systemic examination was normal. An Ultrasound of the abdomen did not reveal any obstruction in the biliary system .All routine investigations required were sent and the patient was started on supportive treatment. Although she had mild elevation of Bilirubin and Liver enzymes, her INR (coagulation profile ) was 4 times the upper limit of normal. While peeping into her liver cell function tests , it was obvious that her liver was failing .She was managed as a fulminant liver cell failure in the Intensive Care Unit of the hospital. What led to her Jaundice and high INR left all of us clueless....
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