Case 19-1987

Presentation of CaseA 64-year-old woman was admitted to the hospital because of jaundice and malaise.The patient was well except for vague hot flashes and diffuse pains of several years' duration. During the four months before admission she lost 6.8 kg in weight, without change in diet, and recently her long-standing migraine headaches were associated with more prominent nausea and "gnawing" abdominal discomfort, without radiation or relation to food. One week before entry prominent fatigue developed. Four days before admission jaundice was noticed, with the passage of dark urine; the fatigue worsened, and the patient felt too ill to . . .