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Grabenstein JD, Musey LK (2014). Differences in serious clinical outcomes of infection caused by specic pneumococcal serotypes among adults. Vaccine 32: 2399-405.

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Article

Unusual Cause of Severe Jaundice in an HIV Infected Patient

1Department of Internal Medicine, Drexel University College of Medicine, Philadelphia, USA

2Department of Infectious Disease and HIV Medicine, Drexel University College of Medicine, Philadelphia, USA

3Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, USA


American Journal of Medical Case Reports. 2018, Vol. 6 No. 4, 61-64
DOI: 10.12691/ajmcr-6-4-2
Copyright © 2018 Science and Education Publishing

Cite this paper:
John R. Woytanowski MD, Benjamin Bluen MD, Jennifer Maning, Ekamjeet Randhawa MD, Shara Epstein MD, Dong Heun Lee MD. Unusual Cause of Severe Jaundice in an HIV Infected Patient. American Journal of Medical Case Reports. 2018; 6(4):61-64. doi: 10.12691/ajmcr-6-4-2.

Correspondence to: John  R. Woytanowski MD, Department of Internal Medicine, Drexel University College of Medicine, Philadelphia, USA. Email: john.woytanowski@tenethealth.com

Abstract

Lobar pneumonia as a cause of jaundice with non-obstructive conjugated hyperbilirubinemia is an uncommon complication of pneumococcus. More commonly seen in immunocompromised and elderly patients, it is believed that the offending microbe produces a toxin that directly causes hepatocellular injury and impairment of bilirubin excretion. Biopsies of patients with pneumococcal pneumonia-associated jaundice commonly depict patchy areas of hepatic necrosis and dilated biliary canaliculi without metastatic foci of infection. In the pre-antibiotic era, the prevalence of jaundice in patients with lobar pneumonia was reported to be about 14% and carried significant mortality rates. Seen less commonly today, mortality rates of invasive pneumococcal disease remain as high as 5% to 35%. We present a case of a 29 year-old-male with no medical history presented with subjective fevers, productive cough, dark urine and myalgias for three days. He was profoundly jaundiced without stigmata of chronic liver disease. Computerized tomography (CT) of the chest revealed a right lower lobe pneumonia. The patient had leukocytosis, significant elevation of transaminases, hyperbilirubinemia and was found to be influenza positive. Antibody for human immunodeficiency virus (HIV) was also positive and later confirmed with polymerase chain reaction (PCR). An extensive workup for his jaundice and hyperbilirubinemia was unrevealing and it was deemed that his clinical signs were a result of invasive pneumococcal infection from his pneumonia. The patient was treated with antimicrobials and highly active antiretroviral therapy (HAART). He ultimately had complete resolution of his jaundice and laboratory abnormalities. Although seen infrequently today, unusual manifestations of pneumococcal infection still occur and may be unrecognized in practice.

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