Case Report

A 54 year-old male with a past medical history of cholangiocarcinoma and portal vein thrombosis was admitted to an outside hospital with right-sided abdominal pain, leukocytosis and hyperbilirubinemia. Prior to admission, he received 3 cycles ofgemcitabine however his tumor had increased in size leading to development of obstructive jaundice. At the hospital, his pain was attributed to hepatomegaly and biliary obstruction secondary to tumor size. He was started on Zosyn for presumed diagnosisof pneumonia and leukocytosis. He was then transferred toThomas Jefferson Hospital for a second opinion regarding his malignancy.

Upon transfer, patient noted right upper quadrant abdominal pain that he described as constant and dull. He also reported fatigue and weight loss over last few months. He denied nausea,vomiting, diarrhea or any change in his bowel movements.