Sickle Hepatopathy and Complex Jaundice in a Primigravida with Hepatitis B Virus Infection: Case Report

Abstract

Background Aim: This article aimed to sensitize the healthcare providers who care for patients with sickle cell disease (SCD) during pregnancy, to the multiple causes of jaundice in sickle hepatopathy, and sift the maze in establishing the dominant cause. Case Presentation: This is a case of a 28-yr-old Gravida 1 Para 0 + 0 health worker, with sickle cell anaemia and background history of peptic ulcer disease, total right hip replacement and previous multiple blood transfusions due to haemolytic crisis. She presented with upper abdominal pain and progressively deepening jaundice. There was minimal relief of the abdominal pain with anti-ulcer medications. She had tender hepatomegaly, positive Murphy’s sign and deranged liver function parameters. She was also positive for viral hepatitis B markers. A remarkable finding on abdominal ultrasonography was that of a gallbladder with normal wall thickness and multiple stones. She was managed conservatively on intravenous fluids, antibiotics and Livolin forte (Phosphatidylcholine) with improved liver function parameters within a week. Conclusion: Since sickle cell hepatopathy is multifactorial, the importance of unravelling the dominant cause of jaundice or liver dysfunction in these patients and the need for immediate intervention are necessary for effective and targeted care, hence this case report. Our patient had background chronic hepatitis B with a superadded acute cholecystitis with non-obstructing gallstones, and possible subsequent bacterial hepatitis, which responded to antibiotics. The most likely dominant cause of jaundice was chronic hepatitis B that was precipitated by acute cholecystitis.