# Unraveling the Yellow Mystery: Severe Jaundice and Multisystem Collapse in a Returning Traveler

## TL;DR

A 43-year-old man with a travel history and possible toxic exposure died from severe jaundice and multiorgan failure, highlighting the dangers of undiagnosed liver and pancreatic diseases.

## Contribution

This case highlights the diagnostic challenges and fatal outcomes of overlapping hepatic and pancreatic pathologies due to unclear toxic exposure.

## Key findings

- The patient exhibited multiorgan dysfunction including acute renal failure, rhabdomyolysis, and disseminated intravascular coagulation.
- Liver biopsy showed cirrhosis with cholestasis, ballooning degeneration, and bridging fibrosis.
- Hemorrhagic pancreatitis with retroperitoneal gas was observed, suggesting pancreatic gas gangrene.

## Abstract

We present the case of a 43-year-old male with recent travel history and possible toxic exposure abroad who was admitted with altered mental status following a seizure. His course was complicated by multiorgan dysfunction, including acute renal failure, rhabdomyolysis, acute pancreatitis, disseminated intravascular coagulation, and severe jaundice. Extensive infectious and autoimmune workup was unrevealing. Imaging revealed hepatosplenomegaly, hemorrhagic ascites, and progressive pancreatic inflammation. Liver biopsy demonstrated cirrhosis with cholestasis, ballooning degeneration, Mallory hyaline, and bridging fibrosis. Despite supportive care, the patient developed hemorrhagic pancreatitis with retroperitoneal gas, concerning for pancreatic gas gangrene. Surgical intervention was not feasible, and the patient ultimately succumbed to his illness. This case underscores the diagnostic complexity and rapidly fatal potential of overlapping hepatic and pancreatic pathologies in the setting of unclear toxic or environmental exposures.