When Birth Control Turns Biliary: A Rare Case of Profound Hyperbilirubinemia From Oral Contraceptives

Oral contraceptives (OCs) are extensively utilized and generally considered safe (reference); nonetheless, infrequent hepatobiliary complications such as cholestasis and hyperbilirubinemia have been documented, particularly among individuals with a genetic predisposition. We present a case involving a 19-year-old female who exhibited significant conjugated hyperbilirubinemia shortly after the commencement of OC therapy. Comprehensive investigations ruled out alternative causes, and the findings from liver biopsy, in conjunction with the clinical context, indicated an estrogen-induced cholestatic injury, likely revealing an underlying Dubin-Johnson syndrome. This case underscores the critical necessity of acknowledging hepatic adverse effects associated with estrogen as well as the influence of genetic susceptibility in drug-related adverse events.