Yellow urticaria in a patient with alcohol-related liver cirrhosis and jaundice

A 61-year-old male patient, admitted at our gastroenterology department with acute cholecystitis, alcohol-related liver cirrhosis, and jaundice [Figure 1] developed several evanescent, oedematous yellowish wheals on his body [Figure 2] over the preceding 24 h. He had been administered intravenous (iv) piperacillin/tazobactam 4.5 g and rifaximin 200 mg thrice daily for last 48 hours. Blood tests revealed raised direct bilirubin (13.87 mg/dl) and SGOT (78 U/L). His antibiotics were switched to iv ciprofloxacin and daptomycin. He received chlorphenamine 4 mg/4 ml iv twice daily for 7 days and his urticaria subsided within 24 h. We made a diagnosis of drug-induced urticaria.

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Figure 1:

Evident conjunctival icterus of the patient

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Figure 2:

Multiple yellowish raised hives on the right arm

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Yellow urticaria is associated with elevated level of serum bilirubin resulting in it’s excess deposition in various tissues like conjunctiva and skin.¹ Other causes of yellow skin discoloration include carotenemia, several drugs, and inherited disorders including Gilbert syndrome.¹