Intracellular cholestasis: a rare complication of malaria falciparum infection

Arab Journal of Gastroenterology : the Official Publication of the Pan-Arab Association of Gastroenterology
Abdel Motaal Mohamed Ahmed, Mohamed B Galib

Abstract

Aside from acute viral hepatitides intracellular cholestasis is seen less often with the use of certain drugs, contrast media, leptospirosis and congenital hyperbilirubinaemias. Types of liver injuries complicating malaria usually take the form of acute hepatitis or haemolytic anaemias rather than cholestasis. We report here a rare presentation where a typical intracellular cholestatic picture complicated malaria falciparum in a patient residing in an endemic area. A 55 year old bank manager presented with malaria fever and deep jaundice for investigations. CBC, LFT, renal function, coagulation profile, liver function test, viral hepatitis markers for HBV and HCV including PCR, U/S liver, MRI liver, CT brain, full septic screen, thin and thick Giemsa-stained blood films and ICT for malaria, leptospira Abs and ANA. Total bilirubin 22 mg/dl, conjugated 19 mg/dl, ALT 49, AST 65, alkaline phosphatase 176 (normal), serum albumin 3.5 mg/dl, INR 0.9, urea 98 mg/dl, creatinine 2.3 mg/dl, Hb 8.8, platelet 263, WBC 11000, MCV 84, Coomb's test negative, haptoglobulin levels: normal, blood culture: negative, HBVDNA and HCVRNA: negative, ANA: negative, blood film and ICT for malaria: positive then turned negative after artemether treatment,...Continue Reading

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