Hyperbilirubinemia without biliary obstruction during amoebic liver abscess treated successfully with endoscopic biliary drainage

Abstract

Amoebic liver abscess with jaundice is not uncommon, but jaundice with intractable pruritus due to it is extremely uncommon. We present a case of amoebic liver abscess who had mild icterus at presentation and improved within seven days of conservative management with the decrease in abscess size. One month later, he presented with severe pruritus and deep jaundice. On evaluation, no other cause could be identified to explain his jaundice and severe pruritus other than a residual abscess. Therefore abscess was drained but neither his jaundice nor pruritus responded to the aspiration of abscess. After one week he underwent endoscopic retrograde cholangiopancreatography (ERCP) and biliary stenting despite he not having any intra or extra-hepatic biliary dilatation. Following biliary drainage, his pruritus improved completely, and bilirubin became normal over the next few days. In conclusion, bilio-vascular fistulas, when present can lead to severe pruritus and, biliary drainage is an effective treatment for it.