Persistent intrahepatic cholestasis secondary to multiple etiologies: a case report - Report - MDSpire

Persistent intrahepatic cholestasis secondary to multiple etiologies: a case report

  • By

  • Ran Wang

  • Yiyang Shang

  • Cai’e Wang

  • Yanhong Gao

  • Wenxiu Zhang

  • Fangbo Gao

  • Yang Guo

  • Baocheng Deng

  • Wenwen Zhang

  • Xingshun Qi

  • June 25, 2026

  • 0 min

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Clinical Report: Persistent Intrahepatic Cholestasis Due to Multiple Causes

Overview

This case report details a 42-year-old man with adult-onset Still's disease who developed persistent severe intrahepatic cholestasis due to multiple overlapping etiologies, including drug-induced liver injury and sepsis.

Background

Intrahepatic cholestasis is a significant manifestation of liver injury that can arise from various causes, complicating diagnosis and management. Identifying the primary etiology is crucial for guiding treatment strategies in complex cases.

Data Highlights

Laboratory TestDay 1Day 3Day 5Day 10
Total Bilirubin (TBIL)318.5 μmol/L336.3 μmol/L359.8 μmol/L389.6 μmol/L
Direct Bilirubin (DBIL)251 μmol/L-321.8 μmol/L301.4 μmol/L
ALT1117 U/L1230.5 U/L1647 U/L2507.0 U/L
AST800 U/L816 U/L1016 U/L961.0 U/L
INR1.592.122.31.54

Key Findings

  • The patient had a history of adult-onset Still's disease and presented with jaundice and severe fatigue.
  • Initial laboratory tests indicated severe liver injury with elevated ALT and AST levels.
  • Drug-induced liver injury was suspected based on the RUCAM score of 5.
  • Sepsis developed, potentially linked to glucocorticoid use and central venous catheter contamination.
  • Persistent liver dysfunction was observed despite treatment with corticosteroids and hepatoprotective agents.
  • Improvement was noted after catheter removal and targeted antibiotic therapy.

Clinical Implications

This case highlights the need for thorough etiological assessment in patients with persistent intrahepatic cholestasis.

Conclusion

This case illustrates the importance of timely reassessment in patients with persistent intrahepatic cholestasis.

Related Resources & Content

  1. EULAR/PReS recommendations for the diagnosis and management of Still's disease, comprising systemic juvenile idiopathic arthritis and adult-onset Still's disease - PubMed
  2. BMC Pregnancy and Childbirth — Assessment of perinatal outcomes in intrahepatic cholestasis of pregnancy in relation to transaminase and bile acid levels
  3. Frontiers in Medicine — Case Report: Clip Migration Induced Recurrent Choledocholithiasis After Laparoscopic Common Bile Duct Exploration
  4. Frontiers in Medicine — Primary sclerosing cholangitis complicated with ulcerative colitis and double gene mutations of UGT1A1 and SLC25A13: a case report
  5. Frontiers in Medicine — The impact of gut microbiome on intrahepatic cholestasis of pregnancy—systematic literature review
  6. AASLD practice guidance on drug, herbal, and dietary supplement–induced liver injury - PMC
  7. Novel Drug Approvals for 2024 | FDA
  8. EULAR/PReS recommendations for the diagnosis and management of Still's disease, comprising systemic juvenile idiopathic arthritis and adult-onset Still's disease - PubMed

Original Source(s)

Persistent intrahepatic cholestasis secondary to multiple etiologies: a case report

  • by Ran Wang, Yiyang Shang, Cai’e Wang, Yanhong Gao, Wenxiu Zhang, Fangbo Gao, Yang Guo, Baocheng Deng, Wenwen Zhang, Xingshun Qi

  • June 25, 2026

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