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.
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