Severe hyperbilirubinemia and coma in chronic congestive heart failure

A 64-year-old man developed severe hyperbilirubinemia of predominantly conjugated fraction in 1978, eight years after a myocardial infarction and development of congestive heart failure. In 1975, he was admitted elsewhere for symptoms suggestive of chronic hepatitis, but liver biopsy revealed replacement of hepatocytes by red blood cells which was interpreted as a result of left-sided cardiac failure. In 1978, liver biopsy showed congestive liver disease with cardiac sclerosis. Despite initial improvement, his condition deteriorated, he became encephalopathic, and died in a coma. This case is reported to illustrate that chronic congestive heart failure can present with severe jaundice and terminate in hepatic coma.