Case history and examination.
A 55-year-old lady presented to the emergency department with fever, epigastric pain and vomiting for one day. She also had 2 bouts of diarrhea. No [preceding constipation.
She had a background of rheumatoid arthritis which was well managed with DMARDS including Methotrexate, Sulphasalazine and Upadacitinib. In addition, she revealed the history of cholecystectomy done 10 years back for cholelithiasis. She presented to the hospital a month back with similar symptoms but was managed conservatively
On examination, her vital signs showed pyrexia of 38.7 with normal heart rate and pulse. She didn’t have any evidence of icterus on examination. She was tender in the epigastrium.