Case Presentation A 65-year-old man with no significant past medical history presented with a one-week history of fever, dry cough, crampy abdominal pain, diarrhea, jaundice, and acute confusion. He had self-administered oral azithromycin for three days without improvement.
Initial Examination Admitted to a local hospital with a provisional diagnosis of fulminant hepatitis versus severe acute cholangitis, complicated by septic shock of chest focus and acute kidney injury Despite broad-spectrum antibiotics, vasopressors, and supportive measures, his condition remained critical, prompting transfer to our hospital’s ICU Clinical Examination Blood pressure: 100/70 mmHg (on noradrenaline weaning) Icteric sclera and right upper quadrant abdominal tenderness Altered mental status, but no focal neurological deficits Laboratory Findings Leukocytosis: 24.6 × 10³/µL Hemoglobin: 9.5 g/dL Platelets:…
