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Case 34

Case 34. History. 51 Y AAM c/o intractable itching, jaundice and 60 lb wt loss > 8 months. Took over the counter medication. Liver biopsy Treated with urso-deoxycholic acid. Hiccups. Pruritus. >8 months. 30 days. 15 days. Persistent pruritus >60 lbs wt loss. chlorpromazine.

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Case 34

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  1. Case 34

  2. History 51 Y AAM c/o intractable itching, jaundice and 60 lb wt loss > 8 months Took over the counter medication Liver biopsy Treated with urso-deoxycholic acid Hiccups Pruritus >8 months 30 days 15 days Persistent pruritus >60 lbs wt loss chlorpromazine

  3. History Lab values were Alkphos-750’s, amino-transferases <100’s, TB-30.0/DB-12.0 Liver biopsy cholestasis with ductopenia, mild sinusoidal fibrosis, mild increase in iron deposition Treatment: Urso-deoxycholic acid

  4. History PMH: Positive for PPD treated in 1980 (meds-unknown) Social History: Worked at Sanitation dept X 25 yrs, No alcohol for 20 yrs ago

  5. Physical Examination Malnourished, Cachetic BMI - 17.9 (Wt-118 lbs, Ht-5’8”) Jaundiced, temporal muscle wasting Otherwise insignificant examination

  6. Laboratory Data Alka Phos: 1100 AST: 80 ALT: 79 TB: 32.6 DB: 30.0 Tot Prot: 6.6 Alb: 2.2 Plt: 697 H/H: 9.0/27.3 Bun: 33 Cr: 1.8 PT-10.6 / INR- 1.0 Hepatitis serology: negative AMA: Neg ANA: Neg IgG: 1150 (nl) IgM: 223 (nl) AFP: 4.6 Ca 19-9: 41.3 (0-31.0 IU/ml TSH: 2.19

  7. Peritoneoscopy

  8. Management Patient was actively listed for Liver Transplant for intractable pruritus Treated with plasmapheresis for pruritus Urso-dexoycholic acid

  9. Follow up Patient regained 25 lbs Persistent Pruritus Weight MELD Bilirubin Albumin INR

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