Ghostine N, Khalil LM, Beydoun K, Berjawi A. Yellow urticaria in a patient with decompensated alcoholic cirrhosis triggered by intravenous albumin infusion: A case report. World J Dermatol 2026; 12(1): 121729 [DOI: 10.5314/wjd.121729]
Corresponding Author of This Article
Ahmad Berjawi, MD Department of Dermatology, Clémenceau Medical Center, Beirut 1100, Beyrouth, Lebanon. ahmadberjawi@proton.me
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Dermatology
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case-report
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Ghostine N, Khalil LM, Beydoun K, Berjawi A. Yellow urticaria in a patient with decompensated alcoholic cirrhosis triggered by intravenous albumin infusion: A case report. World J Dermatol 2026; 12(1): 121729 [DOI: 10.5314/wjd.121729]
World J Dermatol. Sep 16, 2026; 12(1): 121729 Published online Sep 16, 2026. doi: 10.5314/wjd.121729
Yellow urticaria in a patient with decompensated alcoholic cirrhosis triggered by intravenous albumin infusion: A case report
Nour Ghostine, Luna Maria Khalil, Karen Beydoun, Ahmad Berjawi
Nour Ghostine, Luna Maria Khalil, Karen Beydoun, Ahmad Berjawi, Department of Dermatology, Clémenceau Medical Center, Beirut 1100, Beyrouth, Lebanon
Author contributions: Ghostine N and Berjawi A contributed to concept, clinical data collection, and manuscript drafting. Beydoun K and Khalil LM contributed to literature review, critical revision; Berjawi A contributed to supervision, final approval; and all authors have read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Ahmad Berjawi, MD Department of Dermatology, Clémenceau Medical Center, Beirut 1100, Beyrouth, Lebanon. ahmadberjawi@proton.me
Received: April 1, 2026 Revised: April 27, 2026 Accepted: May 9, 2026 Published online: September 16, 2026 Processing time: 168 Days and 12.8 Hours
Abstract
BACKGROUND
Yellow urticaria (YU) is a rare urticarial subtype in which wheals turn distinctly yellow due to bilirubin depositing in the dermis. It surfaces exclusively in patients with significant hyperbilirubinemia. Worldwide, approximately 30 cases have appeared in the literature since its inaugural description in 1969.
CASE SUMMARY
Here is the first documented case of YU in Lebanon. A 70-year-old male with decompensated alcoholic liver cirrhosis (Child-Pugh Class C, score 11) developed an anaphylactoid reaction to intravenous (IV) human albumin infusion. The reaction produced dyspnea, hypotension (systolic blood pressure less than 90 mmHg) and urticarial plaques. Pre-existing hyperbilirubinemia (total bilirubin 10.5 mg/dL with a predominantly direct fraction of 7.2 mg/dL) rendered the wheals strikingly yellow. Management with IV hydrocortisone, topical emollients and antihistamines achieved complete lesion resolution within 24 hours despite persistent hyperbilirubinemia.
CONCLUSION
YU can arise in the setting of predominantly direct hyperbilirubinemia and can be precipitated by blood product infusions. The swift resolution confirms that the urticarial component follows its own natural timeline independently of the underlying hyperbilirubinemia.
Core Tip: Yellow urticaria (YU) is a rare urticarial subtype in which wheals appear yellow due to bilirubin deposition in the dermis during mast-cell degranulation, occurring exclusively in the context of hyperbilirubinemia. We report Lebanon’s first documented case: A 70-year-old male with decompensated alcoholic cirrhosis (Child-Pugh Class C) and predominantly direct hyperbilirubinemia who developed YU following an anaphylactoid reaction to intravenous albumin infusion. Lesions resolved within 24 hours despite persistent hyperbilirubinemia, confirming that urticaria and bilirubin elevation are independent co-existing conditions.
