A 21-year-old male student who re-sides in a university hostel in North Central Nigeria presented to our emer-gency unit with one-week history of fever, upper abdomen pain for five days, and yellow discoloration of the eyes for two days. Fever was high grade, inter-mittent, and associated with chills and rigors, anorexia, malaise, muscle and joint pain, sore throat, and a throbbing headache. He had no history of previous hospital admissions, surgery, blood trans-fusion, or sickle cell disease. There was no history of travels, direct contact with animals, ingestion of unhygienic water or food, or history of unprotected sex. He resided in a hostel where there was recent flooding, which was also infested with rodents and had livestock roaming freely. He denied knowledge of similar illness among his close contacts and those in his vicinity. He did not smoke cigarettes, drink alcohol, or use recrea-tional drugs and was uncertain about previous vaccinations but had always been in good health. He was referred from a primary care hospital on account of the above symptoms after initial resuscitation and investigations. On examination, he appeared well nourished but acutely ill, deeply icteric, febrile (39.1uC), with normal oropharynx, and without palpable lymphadenopathy or rash. The only positive abdominal finding was a palpable tender liver 6 cm below the right costal margin with a span of about 15 cm. There was no localized tenderness, and Murphy's sign was negative. Other systems were normal, except for tachycar-dia of 128 beats per minute. His initial liver biochemistry was as follows: total bilirubin, 113.9 mmol/L (3.4–17 mmol/L); conjugated bilirubin, 86.7 mmol/L (1–8 mmol/L); alkaline phos-phatase, 146 IU/L (21–92 IU/L); alanine transaminase (ALT), 109 IU/L (1–40 IU/ L); aspartate transaminase (AST), 88 IU/ L (1–40 IU/L). The electrolytes were sodium 107 mmol/L (134–145 mmol/L), potassium 3.5 mmol/L (3.5–5.5 mmol/L), creatinine 208 mmol/L (72–126 mmol/L), and urea 3.5 mmol/L (2.5–6.6 mmol/L). Complete blood count revealed a total white cell count (WCC) of 12.0610