49 yrs female with Ulcerative colitis since 3 ½ yrs in remission (last flare 2yrs ago)
■ Presented with fatigue and anorexia since 3mnths
■ Was evaluated elsewhere and was found to have deranged LFT
■ She resorted to CAMs following which she had yellowish discolouration of eyes and urine associated with intense pruritus
■ Currently pruritus resolved, but jaundice persists
■ No H/o GI bleed/ abdominal distention/ Joint pains/ skin rash
On evaluation
■ HB – 11.5
■ PLATELET – 1.6L
■ S.IgG – 3699
■ ANA profile – negative
■ Anti LKM1 – negative
■ ASMA – negative
■ AMA – negative
■ ANCA – negative
■ UGI scopy – no varices
■ Fibroscan – CAP- 223, E(kpa) – 46.1
■ USG abdomen(28/09/20) – Altered and coarse echotexture of liver and caudate lobe hypertrophy
■ Borderline splenomegaly (12.5cms)
■ USG abdomen (16/11/20) – Nodular liver with altered echogenicity and minimal ascites
MRCP(02/10/20)
Mild altered liver parenchymal signal intensity
Mild splenomegaly
Normal biliary system
■ Liver biopsy- Marked areas of necrosis with loss of hepatic parenchyma and bile ductular reaction with moderate mixed inflammation – DDs – AIH /IgG4 related sclerosing cholangitis/DILI.
■ She was started on Wysolone 40mg 4weeks ago
■ Currently asymptomatic except for persistent jaundice