pl help in diagnosis this patient of mine
she is a 57 yrs old lady with no history of jaundice in past presented 13 days ago with fever and burning micturation. initial investigation showed urinary teact infection and was treated emperically with norfloxacin. by 7th day her temp started rising day by day and gradually raised upto 104 degree f.
another set of investigation ruled out typhoid, maleria. urine culture showed e. coli strongly sensitive to amikacin and she was placed on amikacin on 10th day. today morning she was noticed to be pale and jaundiced and she continued to remain febrile with max 100degree f. serum bilirubin is above 4mg% with direct being around 3.6mg%. her sgot, sgpt and alkaline phosphotase are with in normal limits. her creatinine is 1.6mg% and sugar random was 190mg%. i am planning to repeat the usg tomorrow but i am still not clear what could be the cause of high bilirubin with normal enzymes. she is from viral hepatitis endemic area.
please help me what more investigations should i carry out?