A 69-year-old woman with uncontrolled diabetes mellitus presented to the emergency department with a 5-day history of loss of appetite and fever. She reported no sore throat, cough, or abdominal pain. She was febrile and tachycardia, but other vital signs were normal. On physical examination, percussion of the liver was positive for pain, but there were no other abnormal findings. The white cell count was 16,200 per cubic millimeter, the aspartate aminotransferase level was 493 units per liter, and the alanine aminotransferase level was 263 units per liter.
