Jaundice associated with Pseudomonas aeruginosa bacteremia complicating acute leukemia.

Two adult patients with acute leukemia developed marked jaundice during Pseudomonas aeruginosa bacteremia. The progressive increase in serum conjugated bilirubin levels was disproportionate to the gradual decrease in serum alkaline phosphatase and transaminase activity to or below low normal. The production of coagulation factors decreased. Autopsy revealed periportal cholestasis with minimal liver-cell damage. These findings suggested decreased metabolic activity of liver cells associated with bacteremia, probably leading to impaired bilirubin excretion. Both patients died despite appropriate antibiotic therapy. Isolated hyperbilirubinemia, thus, seemed to be an ominous prognostic sign in severe infection.