Hyperbilirubinemia in a Patient With Sepsis: A Diagnostic Challenge

Abstract

Cholestasis due to sepsis is commonly seen in critically ill patients; however, it is often overlooked and poses a challenge in clinical diagnosis and management. In this report, we present a 29-year-old woman who presented to the emergency department with jaundice and symptoms of a urinary tract infection. Initially suspected to be Dubin-Johnson syndrome, sepsis-induced cholestasis was eventually diagnosed after testing. Sepsis should always be considered as part of the differential diagnosis while managing a patient with jaundice. The management of sepsis-induced cholestasis involves treating the underlying infection. In most cases, liver injury improves with the resolution of the infectious process.

Keywords: infection; isolated hyperbilirubinemia; jaundice; sepsis.

Figure 1.

R factor and interpretation of the results of R factor. ALT, alanine aminotransferase; ALP, alkaline phosphatase.

Figure 2.

Workup for abnormal liver blood tests.^, ALP, alkaline phosphatase; ALT, alanine aminotransferase; AST, aspartate aminotransferase; BMI, body mass index ; FBC, full blood count; GGT, gamma-glutamyl transferase; INR, international normalized ratio; NAFLD, nonalcoholic fatty liver disease; OR, odds ratio.