Cholestatic jaundice with urinary tract infection in a child with acute lymphoblastic leukaemia

Abstract

The syndrome of cholestatic jaundice in association with urinary tract infection with normal or slightly elevated liver enzymes has been reported mainly in newborns and infants below 2 months of age. The relative immaturity of the infant's liver and its sensitivity to bacterial endotoxins may explain the occurrence of this syndrome in this age group. A similar syndrome has been reported in adults with severe non-hepatic bacterial infection, including some with urinary tract infection. However, only three case reports in older children could be found. In this report, the case of a 4-year-old girl with acute lymphoblastic leukaemia, who presented with cholestatic jaundice with normal liver enzymes and urinary tract infection, is described. Treatment with antibiotics resulted in resolution of the jaundice and potentially hepatotoxic drugs were used for the treatment of leukaemia with no problems. Two adult patients with acute leukaemia, non-hepatic bacterial infection and cholestatic jaundice have been reported; both died shortly after diagnosis.