“Yellow, and back from Goa”

Jaundice in a young returning traveller with ALT >1000 is acute viral hepatitis until proven otherwise — most likely A or E (faeco-oral) given the travel, and usually self-limiting. But the case is built on two things beyond the diagnosis. First, the public-health duty: he is a CHEF, hepatitis A/E is notifiable and faeco-orally spread, so he must be notified (on clinical suspicion) and excluded from food handling until 7 days after the onset of jaundice (UKHSA, 2024), with household and sexual contacts assessed for hepatitis A vaccine within 14 days of exposure. Second, the hidden agenda: a non-judgemental risk history reveals unprotected sex and an unsterile tattoo abroad and a terror of blood-borne/sexual infection (hep B, C, HIV) and of confessing to his girlfriend. Test the full panel (with HIV consent and honest windows), screen for acute liver failure red flags, give hepatotoxin/alcohol advice, and support the disclosure and partner-testing with compassion rather than a lecture. (Note: jaundice in an OLDER patient is a different animal — refers people aged 40 and over with jaundice on a suspected pancreatic cancer pathway — which does not apply to Jay at 26, and is why pinning the cause matters.)