Cholestasis of Sepsis: A Case Report

A 46-year-old man presented with fever, general lethargy, and weight loss over the last few months. He started to develop jaundice and his condition worsened. Blood tests confirmed rising levels of conjugated bilirubin with near-normal alanine aminotransferase, alkaline phosphatase, and prothrombin time. Imaging of the liver and biliary system, including ultrasound, computed tomography (CT), and magnetic resonance cholangiopancreatography (MRCP), did not show any focal lesion or biliary obstruction. Human immunodeficiency virus (HIV) and hepatitis screening were negative. A chest x-ray showed no consolidation. An echocardiogram showed no evidence of endocarditis. An ultrasound of the neck and axilla did not show any enlarged lymph nodes. A chest CT scan revealed a mediastinal abscess that contained acid-fast bacilli when aspirated and stained. The patient was started on first-line antituberculous treatment. The jaundice was thought to be secondary to cholestasis of sepsis and resolved completely over the subsequent weeks. His bilirubin levels returned to normal after treatment initiation.

Keywords: mediastinal abscess; tuberculosis.