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A 24-year-old male presented with a 4-week history of right upper quadrant pain, lethargy, pyrexia, night sweats, anorexia and weight loss. Past medical history included Coeliac disease (compliant with a gluten free diet) and liver cysts. On examination the patient had a temperature of 38.2°C and tender hepato-splenomegaly. Blood tests showed bilirubin 16 μmol/L (normal range 10–20 μmol/L), ALT 28 IU/L (normal range 10–50 IU/L), ALP 274 IU/L (normal range 40–129 IU/L), albumin 48 g/L (normal range 34–50 g/L), GGT 205 (normal range 10–71 IU/L), INR 1.05 (normal range 0.9–1.1), WCC 14 (normal range 3–10 × 109) and CRP 199 mg/L (normal range …
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