Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 7, 2018; 24(13): 1486-1490
Published online Apr 7, 2018. doi: 10.3748/wjg.v24.i13.1486
Gilbert syndrome combined with prolonged jaundice caused by contrast agent: Case report
Jian-Dan Qian, Feng-Qin Hou, Tai-Ling Wang, Chen Shao, Gui-Qiang Wang
Jian-Dan Qian, Feng-Qin Hou, Gui-Qiang Wang, Department of Infectious Diseases and the Center for Liver Diseases, Peking University First Hospital, Beijing 100034, China
Tai-Ling Wang, Department of Pathology, China-Japan Friendship Hospital, Beijing 100029, China
Chen Shao, Department of Pathology, Beijing YouAn Hospital Capital Medical University, Beijing 100069, China
Gui-Qiang Wang, The Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Gui-Qiang Wang, Peking University International Hospital, Beijing 102206, China
Author contributions: Qian JD designed and wrote the report; Hou FQ reviewed the manuscript for its intellectual content and revised the entire work; Wang TL and Shao C performed the histological assessments and evaluations; Wang GQ reviewed the manuscript for its intellectual content.
Supported by National Natural Science Foundation of China, No. 81470849.
Informed consent statement: The patient involved in this study gave written informed consent authorizing the use and disclosure of his protected health information.
Conflict-of-interest statement: The authors of this manuscript have no conflicts of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Gui-Qiang Wang, MD, PhD, Professor, Department of Infectious Diseases and the Center for Liver Diseases, Peking University First Hospital, 8 Xishiku Dajie, Xicheng District, Beijing 100034, China.
Received: January 19, 2018
Peer-review started: January 20, 2018
First decision: February 3, 2018
Revised: February 7, 2018
Accepted: February 26, 2018
Article in press: February 26, 2018
Published online: April 7, 2018
Case characteristics

A middle-aged male patient presented with abdominal pain, jaundice and dark urine.

Clinical diagnosis

The only physical sign of this case was a mild abdominal tenderness.

Differential diagnosis

Viral hepatitis, other viruses infection (cytomegalovirus, Epstein-Barr virus), autoimmune liver disease, IgG-4-related cholangitis, and benign recurrent intrahepatic cholestasis.

Laboratory diagnosis

The liver test results showed total bilirubin 268.7 μmol/L, direct bilirubin 114.4 μmol/L, alanine aminotransferase 155 IU/L, aspartate aminotransferase 71 IU/L, alkaline phosphatase 172 IU/L, and gamma-glutamyl transpeptidase 424 IU/L.

Imaging diagnosis

Abdominal computed tomography showed the presence of cholecystolithiasis, with features of cholecystitis and dilation of the common bile duct (CBD) and intrahepatic ducts due to a distal CBD obstruction.

Pathological diagnosis

A liver biopsy showed marked bilirubinostasis in zones 3 and 2, canaliculi with no evidence of portal tract inflammation or interphase hepatitis, no lesions or paucity of bile ducts, and no bile infarcts or leaks.


The patient was prescribed phenobarbital, ursodeoxycholic acid, prednisolone and cholestyramine. In addition, with the worsening of cholestasis, bilirubin serum adsorption treatments were performed a total of four times.

Related reports

Prolonged cholestasis is a very rare complication of endoscopic retrograde cholangiopancreatography (ERCP), and few cases of this complication are reported in the English literature. The exact mechanism of this complication, however, remains unknown. No cases of post enhanced magnetic resonance cholangiopancreatography (MRCP)-related jaundice have been reported.

Term explanation

ERCP: Endoscopic retrograde cholangiopancreatography, which can be used for the diagnosis of cholelithiasis.

Experiences and lessons

Our patient’s case illustrates a rare drug-induced liver injury due to contrast agents, which presented as prolonged cholestasis following “successful” therapeutic ERCP for an obstructing distal CBD stone and an enhanced-MRCP that excluded residual stones. Clinicians must be aware that ERCP and MRCP with the contrast agents iopromide and gadoterate meglumine may have the possibility of inducing prolonged hyperbilirubinemia.