Acute Sepsis-Induced Cholestatic Disease Presenting With Isolated Hyper-Bilirubinemia

Abstract

Sepsis-induced cholestatic disease occurs in a fair amount of critically-ill patients. Although the mechanism is poorly understood, hypoperfusion to the liver is one of the most common mechanisms that lead to liver dysfunction and subsequently biliary disease. Hepatic conditions such as cirrhosis and hepatitis A may have an impact on how sepsis-induced cholestatic disease can present. Understanding the presentation of sepsis-induced cholestasis and addressing the underlying cause of sepsis can certainly lead to better outcomes without the need for procedure intervention. We explore a patient with acute sepsis-induced cholestatic disease who had recently-resolving hepatitis A infection and underlying cirrhosis.

Keywords: cholestatic liver disease; cirrhosis; gastroenterology; hepatitis-a; severe sepsis.

Figure 1. A: Right upper quadrant ultrasound,  B: Doppler ultrasound, C: TIPS flow rates (proximal (a), middle (b), and distal (c)) with shunt velocities in the proximal, middle, and distal stents measuring at 12, 39, and 65 cm/s, respectively.

TIPS: Transjugular intrahepatic portosystemic shunt

Figure 2. CT scan showing diffuse subcutaneous infiltration