Acute Osteomyelitis Presenting As Cholestatic Jaundice

Abstract

Cholestatic jaundice is a well recognised complication of late sepsis. However, cholestatic liver injury preceding sepsis is less well known and appreciated. This leads to delays in diagnosis in clinical practice and may result in significant morbidity and mortality. The development of a cholestatic blood picture should be considered as an early warning sign of an underlying infection, even in the absence of signs or symptoms of sepsis. This report describes the case of a previously healthy patient who presented with cholestatic jaundice. Staphylococcal osteomyelitis involving the left sacroiliac joint was diagnosed. Literature relating to cholestatic jaundice in sepsis is reviewed.

The erroneous perception of a clinical sign: Cholestasis preceding sepsis mimicking hepatitis in an adolescent patient

“…Isolated cholestasis preceding sepsis has been previously reported in adult patients but only scarcely in children and adolescents. 4,5 Whereas in the absence of fever and abnormal vital signs, physicians may be more inclined to consider viral hepatitis, inherited disorders, or autoimmune diseases as possible causes of cholestasis, the high liver (SOFA 2) and coagulation (SOFA 2) SOFA scores already at initial presentation and the further increased liver SOFA score on representation (SOFA 4) should have facilitated early recognition of a patient with sepsis or at risk for sepsis. 3 Hepatic injury is a well-described complication of late sepsis and accounts for up to 20% of cholestatic jaundice in patients of all ages.…”

Osteoarticular infection of the symphysis pubis and sacroiliac joints in active young sportsmen

“…In a similar case reported in 2006, a man was diagnosed with staphylococcal osteomyelitis of the left sacroiliac joint. 10 His localising signs were preceded by jaundice, which resolved completely with antimicrobial treatment.…”