Case Report

A 28 year-old male was referred to the gastroenterology clinic for evaluation of abnormal liver enzymes. Three months prior to presentation he was evaluated at a local emergency department for vomiting and upper abdominal pain. He described pain as epigastric and worse after eating. He denied fever, chills orchanges in his urine. At that time, the patient was not jaundiced but reported having a rash. Laboratory testing was remarkablefor elevated liver enzymes (Table 1). The patient was advised to follow up with his primary care physician. Though his symptoms resolved without medical therapy, liver enzymes obtained a few weeks later by his primary physician demonstrated progressive elevation and he was referred to the gastroenterology (GI) clinic for further evaluation.