Isolated Conjugated Hyperbilirubinemia in Seriously Ill Children – Don’t Forget Sepsis!

Background: Jaundice is frequently associated with extrahepatic systemic infections. The important causes include increased bilirubin levels due to hemolysis, hepatic dysfunction, reduced excretion and cholestasis. Sepsis induced cholestasis has a unique pathophysiologic basis. Although common in gram negative sepsis among neonates, the clinical features of sepsis induced cholestasis are not widely recognized older children.Case report: We present a 6 year old, premorbidly asymptomatic boy with community acquired MRSA sepsis-pneumonia and ARDS (Acute respiratory distress syndrome) with isolated conjugated hyperbilirubinemia. A diagnosis of sepsis induced isolated cholestasis was considered after ruling out other possible causes of cholestasis. The hyperbilirubinemia improved with improvement in the primary pathology.Conclusion: Early recognition of sepsis as a cause of isolated cholestatic jaundice would avoid unnecessary investigations and therapy would help in early institution of appropriate therapy.