This patient presented with prolonged jaundice of unknown etiology. Laboratory results showed elevated liver enzymes, elevated total and direct bilirubin, and a reactive hepatitis B surface antigen test. However, other hepatitis B markers were non-reactive, creating a diagnostic dilemma. The clinical presentation and lab results were most consistent with hepatocellular jaundice likely due to hepatitis B. Further testing including quantitative hepatitis B surface antigen and hepatitis B DNA were recommended to clarify the hepatitis profile and help determine the etiology and appropriate treatment.