Jaundice associated with lobar pneumonia. A clinical, laboratory and histological study

Twenty-eight patients with jaundice associated with lobar pneumonia have been studied. The epidemiological and clinical features were compared with 70 patients with lobar pneumonia without jaundice. Jaundice was associated with a predominance of males, a high incidence of right lower lobe consolidation and hepatic tenderness. Although the jaundiced patients remained pyrexial for longer it was not associated with a poor prognosis. There was no evidence of immunological deficiency although pneumococcal polysaccharide antigenaemia was commoner in jaundiced patients. Laboratory investigations showed evidence of haemolysis in the majority of jaundiced patients and the cause of this was found to be G6PD deficiency. Starch-yel electrophoresis demonstrated that the phenotype was A- in deficient patients. Hepatic function tests were unhelpful. Light and electron microscopical changes consistent with haemolysis were present in liver biopsies from G6PD deficient patients although hepatocellular damage and cholestasis were also present.