Yellow urticaria in a patient with decompensated alcoholic cirrhosis triggered by intravenous albumin infusion: A case report

Table 1 Laboratory results at admission

Parameter	Value	Reference range	Interpretation
Liver function
Total bilirubin (mg/dL)	10.5	0.2-1.2	↑ markedly elevated
Direct bilirubin (mg/dL)	7.2	0-0.3	↑↑ predominantly direct
Indirect bilirubin (mg/dL)	3.3	0.2-0.9	↑ elevated
ALT (U/L)	68	7-56	↑ mildly elevated
AST (U/L)	95	10-40	↑ elevated
ALP (U/L)	210	44-147	↑ elevated
GGT (U/L)	320	8-61	↑↑ markedly elevated
Albumin (g/dL)	2.2	3.5-5.0	↓ low - hepatic synthetic failure
INR	1.9	0.8-1.1	↑ coagulopathy
PT (seconds)	22	11-13.5	↑ prolonged
Renal function & electrolytes
Creatinine (mg/dL)	1.3	0.7-1.3	Upper normal
BUN (mg/dL)	28	7-20	↑ mildly elevated
Sodium (mEq/L)	132	136-145	↓ hyponatremia
Potassium (mEq/L)	4.1	3.5-5.1	Normal
Complete blood count
Hemoglobin (g/dL)	10.2	13.5-17.5	↓ anemia
Platelets (× 103/µL)	98	150-400	↓ thrombocytopenia
MCV (fL)	105	80-100	↑ macrocytosis
Coagulation & inflammatory markers
aPTT (seconds)	42	25-35	↑ prolonged
Fibrinogen (mg/dL)	180	200-400	↓ low
CRP (mg/L)	48	< 5	↑↑ significantly elevated
Ammonia (µmol/L)	72	9-33	↑ elevated
HBsAg/anti-HCV	Negative	Negative	—

ALT: Alanine aminotransferase; ALP: Alkaline phosphatase; aPTT: Activated partial thromboplastin time; AST: Aspartate aminotransferase; BUN: Blood urea nitrogen; CRP: C-reactive protein; GGT: Gamma-glutamyl transferase; INR: International normalised ratio; MCV: Mean corpuscular volume; HBsAg: Hepatitis B surface antigen; HCV: Hepatitis C virus; PT: Prothrombin time.

Table 2 Summary of previously published cases of yellow urticaria

Ref.	Year	Age/sex	Underlying condition	Peak bilirubin (mg/dL)	Urticaria trigger	Treatment
Clarke[4]	1969	Adult/male	Hepatic cirrhosis	Elevated (NR)	Idiopathic	Antihistamines
Nava Cruz et al[2]	2017	57 years/female	Biliary pancreatitis	8.4	Idiopathic	Antihistamines
Combalia et al[1]	2017	63 years/male	Cirrhosis	9.3	Drug	Antihistamines
Combalia et al[1]	2017	38 years/female	AIH/PBC overlap	7.8	Idiopathic	Antihistamines
Çakıcı et al[3]	2021	Adult/NR	Viral hepatitis B	5.9	Idiopathic	Antihistamines
Mendes et al[10]	2018	Adult/NR	ARV-induced liver injury	4.5	Drug (ARV)	Cessation + antihistamines
Hardy et al[9]	2022	67 years/male	End-stage liver disease	12.1	FFP transfusion	Antihistamines
Kalsi et al[6]	2024	Adult/NR	Acalabrutinib hepatotoxicity	6.8	Drug	Cessation + steroids
Toujani et al[8]	2023	33 years/female	AIH + PBC overlap	6.2	Idiopathic	Antihistamines
Gao et al[7]	2025	Adult/NR	Uncommon aetiology (NR)	NR	Idiopathic	Antihistamines
Present case	2025	70 years/male	Decompensated alcoholic cirrhosis (CPC 11)	10.5 (direct 7.2)	IV albumin (anaphylactoid)	IV hydrocortisone + chlorpheniramine + emollients

AIH: Autoimmune hepatitis; ARV: Antiretroviral; CPC: Child-Pugh Class; FFP: Fresh frozen plasma; NR: Not reported; PBC: Primary biliary cholangitis; IV: Intravenous.