A 52-year-old man presented with fever associated with malaise and vomiting a day prior to admission. He had emigrated from Ethiopia to the United States 22 years prior and had portal hypertension secondary to schistosomiasis. A transjugular intrahepatic portosystemic shunt had been placed for variceal bleeding 4 years prior. Except for splenomegaly, the physical examination was unremarkable. He had lymphopenia and elevated serum aminotransferases (aspartate aminotransferase 194 U/L, alanine aminotransferase 164 U/L). Test for severe acute respiratory syndrome coronavirus 2 was negative. Abdominal computed tomography showed pneumobilia (Figure). Review of the medical records showed that pneumobilia had remained unchanged compared with the abdominal computed tomography scan taken 4 years earlier. With negative blood cultures, positive influenza test, decreasing aminotransferases, and clinical improvement, he was given supportive treatment and discharged.
      FigureAbdominal computed tomography shows pneumobilia (white arrows), transjugular intrahepatic portosystemic shunt (black arrow), and splenomegaly (red asterisk).
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