Unusual Cause of Severe Jaundice in an HIV Infected Patient

John R. Woytanowski MD^1, , Benjamin Bluen MD², Jennifer Maning³, Ekamjeet Randhawa MD¹, Shara Epstein MD² and Dong Heun Lee MD²

¹Department of Internal Medicine, Drexel University College of Medicine, Philadelphia, USA

²Department of Infectious Disease and HIV Medicine, Drexel University College of Medicine, Philadelphia, USA

³Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, USA

Cite this paper

John R. Woytanowski MD, Benjamin Bluen MD, Jennifer Maning, Ekamjeet Randhawa MD, Shara Epstein MD and Dong Heun Lee MD. Unusual Cause of Severe Jaundice in an HIV Infected Patient. American Journal of Medical Case Reports. 2018; 6(4):61-64. doi: 10.12691/AJMCR-6-4-2

Abstract

Lobar pneumonia as a cause of jaundice with non-obstructive conjugated hyperbilirubinemia is an uncommon complication of pneumococcus. More commonly seen in immunocompromised and elderly patients, it is believed that the offending microbe produces a toxin that directly causes hepatocellular injury and impairment of bilirubin excretion. Biopsies of patients with pneumococcal pneumonia-associated jaundice commonly depict patchy areas of hepatic necrosis and dilated biliary canaliculi without metastatic foci of infection. In the pre-antibiotic era, the prevalence of jaundice in patients with lobar pneumonia was reported to be about 14% and carried significant mortality rates. Seen less commonly today, mortality rates of invasive pneumococcal disease remain as high as 5% to 35%. We present a case of a 29 year-old-male with no medical history presented with subjective fevers, productive cough, dark urine and myalgias for three days. He was profoundly jaundiced without stigmata of chronic liver disease. Computerized tomography (CT) of the chest revealed a right lower lobe pneumonia. The patient had leukocytosis, significant elevation of transaminases, hyperbilirubinemia and was found to be influenza positive. Antibody for human immunodeficiency virus (HIV) was also positive and later confirmed with polymerase chain reaction (PCR). An extensive workup for his jaundice and hyperbilirubinemia was unrevealing and it was deemed that his clinical signs were a result of invasive pneumococcal infection from his pneumonia. The patient was treated with antimicrobials and highly active antiretroviral therapy (HAART). He ultimately had complete resolution of his jaundice and laboratory abnormalities. Although seen infrequently today, unusual manifestations of pneumococcal infection still occur and may be unrecognized in practice.

Keywords

streptococcus pneumoniae, jaundice, HIV, hyperbilirubinemia

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

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