A 28-year-old man with a history of chromosomal translocation 13/14 and no prior liver disease presented to the hospital with a complaint of fevers, non-bloody emesis, and dark urine. History His history revealed ingestion of diphenhydramine 400 mg nightly, taken for insomnia, over the previous 4 months; the medication was inspected in the hospital and confirmed not to contain acetaminophen. He denied use of herbal compounds, supplements, teas, and any other medication. The patient endorsed rare alcohol consumption and rare intranasal cocaine use in the distant past.
Family history was notable for possible statin-induced liver disease and hereditary angioedema. Examination Vital signs on presentation were within normal limits. Physical exam revealed icteric conjunctiva, a 15 cm liver palpable 3 cm below the right costal margin, nonpalpable spleen, normal mentation, and neurologic exam…
