Cholestasis of Sepsis: A Case Report

Area of Science:

• Internal Medicine
• Infectious Diseases
• Gastroenterology

Background:

• Jaundice can present with diverse underlying etiologies.
• Hepatobiliary and systemic infections are common causes of cholestatic jaundice.

Observation:

• A 46-year-old man presented with fever, lethargy, and weight loss, progressing to jaundice.
• Initial investigations including liver function tests and advanced imaging revealed no focal liver or biliary pathology.
• Extensive workup for infectious and inflammatory causes, including human immunodeficiency virus (HIV) and hepatitis, was negative.

Findings:

• A chest CT scan identified a mediastinal abscess.
• Aspiration and staining revealed acid-fast bacilli within the abscess.
• The patient was diagnosed with tuberculosis and initiated on antituberculous treatment.

Implications:

• This case highlights a rare presentation of tuberculosis manifesting as cholestatic jaundice.
• Mediastinal abscess should be considered in the differential diagnosis of unexplained jaundice, especially with systemic symptoms.
• Prompt antituberculous treatment can effectively resolve jaundice secondary to sepsis and cholestasis.