A 31-year-old man was hospitalized with a history of nausea, vomiting, fever of 38°C, and diarrhea for 3 days. He had progressive jaundice for several months. His past medical history included ulcerative colitis, diabetes mellitus, chronic renal insufficiency, and pulmonary embolism. He had orthotopic liver transplantation secondary to primary sclerosing cholangitis 5 years ago but required retransplantation secondary to hepatic vein thrombosis 6 months later. He also had a chronic right hepatic hydrothorax for which he had an indwelling pleural catheter through which he self-drained fluid regularly. His medications included tacrolimus, insulin, mesalamine, hydromorphone, and promethazine. He denied any history of alcohol or tobacco abuse, recent trauma, or surgery.