A 25-year-old white woman had a history of biliary atresia. At age 3 weeks, she underwent a Kasai procedure, and at age 19 years, she underwent a live donor adult liver transplant (LDALT) with a Roux-en-Y hepaticojejunostomy. Approximately 5 years post transplant, the patient developed persistent pruritus, jaundice, and malaise and underwent biliary anastomotic dilation. Three weeks later, she developed acute tubular necrosis (ATN) due to tacrolimus toxic effects and was admitted to the hospital for hydration. Despite resolution of the ATN, the patient remained persistently jaundiced, and she underwent percutaneous transhepatic cholangiography with dilation of the anterior biliary ducts and removal of biliary stones. Drains were placed into the anterior and posterior biliary systems. The patient received 1 dose of intravenous levofloxacin on the day of the procedure.
Aaron RS, Zacharias I, Mannion S, Gordon FD. Rare Cutaneous Manifestation of Hyperbilirubinemia. Arch Dermatol. 2010;146(2):209-210. doi:10.1001/archdermatol.2009.383