Scleral Icterus

We present a case of acute fulminant liver failure from a liver detoxification tea. We present a 60-year-old female with weakness, lethargy, scleral icterus, jaundice, and worsening mental status. She drank herbal tea three times a day for 14 days prior to symptom development. Liver tests were elevated. Remaining laboratory tests and imaging were negative for other etiologies. An ultrasound-guided liver biopsy showed submassive necrosis. A literature search on the ingredients shows six ingredients as having hepatotoxic effects and remaining ingredients as having very sparse hepatoprotective data. Healthcare professionals should discuss herbal medication and tea use and report adverse effects.

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Rare case of endogenous Klebsiella endophthalmitis associated with emphysematous prostatitis in a patient with diabetes, cirrhosis and COVID-19

BMJ Case Reports ◽

10.1136/bcr-2020-240425 ◽

2021 ◽

Vol 14 (4) ◽

pp. e240425

Author(s):

Alexander B Crane ◽

Monica C Abreu Diaz ◽

Yi Jiang ◽

Kathleen Mangunay Pergament

Keyword(s):

Pars Plana Vitrectomy ◽

Rare Case ◽

Vision Loss ◽

Urine Culture ◽

Suprapubic Catheter ◽

Prostatic Abscess ◽

Intravenous Antibiotics ◽

Pars Plana ◽

Scleral Icterus

A 35-year-old Hispanic man presented with fever, chills, dysuria, diarrhoea, scleral icterus, tachycardia and tachypnea. He was found to be COVID-19 positive, CT of the pelvis revealed prostatic abscess, and urine culture grew Klebsiella pneumoniae. Additionally, he was found to have diabetes and cirrhosis. During treatment, the patient developed vision loss, and was diagnosed with endogenous Klebsiella endophthalmitis. The patient was treated with intravenous antibiotics, pars plana vitrectomy, intravitreal antibiotics and cystoscopy/suprapubic catheter placement. On follow-up, the patient has had the suprapubic catheter removed, and successfully passed a voiding trial, but suffers permanent vision loss in both eyes.

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'Conjunctival icterus,' not 'scleral icterus'

JAMA ◽

10.1001/jama.242.23.2558d ◽

1979 ◽

Vol 242 (23) ◽

pp. 2558d-2558

Author(s):

R. C. Tripathi

Keyword(s):

Scleral Icterus

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Atypical case of syphilitic hepatitis

BMJ Case Reports ◽

10.1136/bcr-2020-237851 ◽

2021 ◽

Vol 14 (3) ◽

pp. e237851

Author(s):

Elliott Goldberg ◽

Bathai Edwards ◽

Kaleigh Krill

Keyword(s):

Abdominal Pain ◽

Herpes Simplex ◽

Antinuclear Antibodies ◽

Maculopapular Rash ◽

Antimitochondrial Antibodies ◽

Atypical Case ◽

Intravenous Acyclovir ◽

Simplex Virus ◽

Elevated Transaminases ◽

Scleral Icterus

A 31-year-old immunocompetent, heterosexual man with no relevant medical history presented with 1 week of jaundice, abdominal pain, cough and headache. Examination revealed scleral icterus, right upper quadrant tenderness and hepatomegaly. Initial investigations revealed hyperbilirubinaemia and elevated transaminases. Serum studies were positive for antinuclear antibodies, antimitochondrial antibodies, and herpes simplex virus IgM. Despite being started on intravenous acyclovir, his bilirubin and transaminase levels continued to rise. He was subsequently tested for syphilis given his maculopapular rash on the soles of his feet and it returned positive. He improved clinically with the initiation of penicillin. In this case, we will discuss the presentation, diagnosis and treatment of syphilitic hepatitis.

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