A 24-year-old Haitian female with no known medical comorbidities presented to UnityPoint Health–Allen Memorial Hospital (Waterloo, IA, USA) with abdominal pain (day 1). Laboratory tests revealed mildly elevated aminotransferase levels (aspartate aminotransferase [AST] 70 units per L and alanine aminotransferase [ALT] 33 units per L). Abdominal and pelvic CT suggested cholelithiasis and bilateral inguinal adenopathy, with typical liver parenchyma. Given persistent abdominal pain, a hepatobiliary iminodiacetic acid scan was obtained (day 4), which suggested acute cholecystitis and prompted a cholecystectomy and right inguinal lymph node excisional biopsy (day 4).
Source link