Case history

Case history

A 20-year-old man presents with jaundice that started 2 days after the onset of sore throat, fever, and chills. He reports a history of intermittent jaundice over the last 5 years. Symptoms of fever, chills, and sore throat have resolved with penicillin therapy, but the jaundice has persisted. He has no other past medical history, but a family member has experienced similar episodes of intermittent jaundice.

Other presentations

Patients sometimes report vague abdominal complaints and fatigue, although this does not seem to represent any serious pathology and may be related to anxiety and exhaustive investigations for jaundice.[1][2][3] Although hepatomegaly is sometimes seen, liver function tests including bile acids are normal and there is no evidence of hemolysis.[1][3][4] Serum bilirubin often fluctuates and occasionally bilirubin measurements may be within normal limits. By contrast with syndromes associated with true cholestasis, there is no pruritus.[5][6] The disease can develop gradually or acutely, often triggered by an intercurrent illness, alcohol, oral contraceptives, or pregnancy.[5] A high frequency of fetal loss has been reported in women with DJS, although the reasons for this association are not clear.[7][8] Chronic cholecystitis and cholelithiasis have been linked, but this may be a coincidental finding.[5][9][10]

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