DOI: 10.1373/clinchem.2010.144527


A 31-year-old woman was admitted into a regional hospital for abdominal pain, decreased appetite, malaise, confusion, and tea-colored urine. Investigations showed acute liver failure with a markedly decreased liver function characterized by greatly increased aminotransferases, bilirubin concentration, prothrombin time, and international normalized ratio. There was no history of liver disease or intake of herbal medicines or over-the-counter medications. Her condition worsened 2 days later, and she was transferred to our hospital for further management and the possibility of liver transplantation. A physical examination revealed a jaundiced woman in a fair general condition and with a soft but tender right upper quadrant with no guarding or rebound tenderness of the abdomen. She went into a semicomatose state 1 day later.