A 77 year old Bangladeshi man presented with jaundice, abdomnal discomfort and reduced appetite for 3–4 weeks. He had no ecent foreign travel, did not use recreational drugs and was not mmunosuppressed. He had a background of atrial fibrillation, type diabetes mellitus, hypertension and congestive cardiac failure. His liver function tests were deranged with total bilirubin: 85 mol/L (normal <21 mol/L), alkaline phosphatase (ALP): 78 unit/L (normal <130 unit/L) and alanine aminotransferase ALT): 842 unit/L (normal <40 unit/L). An abdominal ultrasound can showed no abnormalities. Auto-antibody screen, hepatitis C, and HIV serology were negative; current and previous hepatitis virus (HBV) serology results are shown in Table 1. He was admitted to hospital and antiviral therapy (entecavir .15 mg once daily, adjusted for renal function) was started. In pite of initial stabilisation, he deteriorated with progressive liver ysfunction and died from decompensated liver failure.