BACKGROUND:The presence of dual pathology can cause diagnostic dilemmas. We present a case of adenocarcinoma of the ampulla of Vater with concurrent amiodarone hepatotoxicity. METHODS:Painless jaundice associated with a palpable gallbladder was investigated clinically,radiologically endoscopically and via liver biopsy. RESULTS:Liver biopsy showed amiodarone hepatotoxicity Endoscopic biopsy identified an ampullary adenoma However,the endoscopic ultrasound and intra-operative findings suggested a malignancy,which was confirmed postoperatively. CONCLUSIONS:While the classic findings of Courvoisier’s Law are borne out in this case,the etiology of jaundice is twofold. Although dual pathology is uncommon it should always be considered. METHOD: The presence of dual pathology can cause diagnostic dilemmas. We present a case of adenocarcinoma of the ampulla of Vater with concurrent amiodarone hepatotoxicity. METHODS: Painless jaundice associated with a palpable gallbladder was investigated clinically, radiologically endoscopically and via liver biopsy. RESULTS: Liver biopsy showed amiodarone hepatotoxicity, the endoscopic ultrasound and intra-operative findings suggested a malignancy, which was confirmed postoperatively. CONCLUSIONS: While the classic findings of Courvoisier’s Law are borne out in this case, the etiology of jaundice is twofold. Although dual pathology is uncommon it should always be considered.