Unraveling the Yellow Mystery: Severe Jaundice and Multisystem Collapse in a Returning Traveler

We present the case of a 43-year-old male with recent travel history and possible toxic exposure abroad who was admitted with altered mental status following a seizure. His course was complicated by multiorgan dysfunction, including acute renal failure, rhabdomyolysis, acute pancreatitis, disseminated intravascular coagulation, and severe jaundice. Extensive infectious and autoimmune workup was unrevealing. Imaging revealed hepatosplenomegaly, hemorrhagic ascites, and progressive pancreatic inflammation. Liver biopsy demonstrated cirrhosis with cholestasis, ballooning degeneration, Mallory hyaline, and bridging fibrosis. Despite supportive care, the patient developed hemorrhagic pancreatitis with retroperitoneal gas, concerning for pancreatic gas gangrene. Surgical intervention was not feasible, and the patient ultimately succumbed to his illness. This case underscores the diagnostic complexity and rapidly fatal potential of overlapping hepatic and pancreatic pathologies in the setting of unclear toxic or environmental exposures.