The patient is a 69 year-old male with new onset jaundice of two weeks and a 6 month history of progressive hyperbilirubinemia with cholestasis who was admitted for evaluation. Physical examination revealed a well developed and well nourished, jaundiced male with scleral icterus, a II/VI systolic murmur at apex, mild abdominal discomfort over epigastrum on palpation without discernable hepatomegaly, normal distal pulses, no lower extremity edema, and no stigmata of chronic liver disease. Laboratory investigation revealed a total bilirubin of 19.3 mg/dL, alkaline phosphatase 693 U/L, and AST and ALT of 140 U/L and 117 U/L, respectively. CT scan of the abdomen and pelvis showed multiple foci of arterial enhancement, periportal edema without biliary dilatation, concerning for acute fulminant hepatitis. The patient had a dramatic and rapid decline the day following admission, developing cardiac arrhythmia and hypotension and subsequently died despite resuscitative efforts.