A 61-year-old woman with a history of uncontrolled type 2 diabetes mellitus presented with progressive right upper quadrant abdominal pain of 1 month’s duration. The pain was sharp, intermittent without radiation, and not exacerbated by eating. She had no subjective fevers, nausea, vomiting, diarrhea, or weight loss. She had immigrated from Chuuk, Micronesia, to Hawaii 10 years ago and had not traveled overseas since. She denied alcohol use or contact with animals such as pigs.