ERCP — Choledocholithiasis Filling Defect

A 58-year-old woman presents to the emergency department with fever (38.8°C), right upper quadrant pain, and jaundice. Laboratory tests show total bilirubin 5.2 mg/dL, ALP 320 U/L, and AST 180 U/L. ERCP is performed and reveals a dilated common bile duct with the filling defects marked **B** in the diagram. Which of the following clinical presentations would most strongly indicate that this patient requires URGENT biliary decompression rather than elective management?