Atypical Presentation of Alcoholic Liver Disease as Isolated Direct Hyperbilirubinaemia with Non Resolving Pneumonia Secondary to Multidrug Resistant Escherichia coli and Aspergillus Co-infection: A Case Report

Abstract

It is uncommon for a patient with Alcoholic Liver Disease (ALD) to arrive with solitary hyperbilirubinaemia that is not accompanied by substantial hepatic abnormalities. Patients with ALD are more likely to develop bacterial and Invasive Fungal Infections (IFI) early in the course of their disease and both are linked with more severe systemic inflammation, a poorer clinical prognosis, and a higher mortality. Because of escalating antibiotic usage, lengthy hospital stays, and intensive medical procedures, hospitalised cirrhotic patients are increasingly at risk of acquiring IFI. In patients with alcoholic liver failure, persistent IFI are a primary cause of death and treatment resistance. This was a case of a 34-year-old male with an unusual combination of worsening sepsis and worsening jaundice without any other significant abnormalities in liver function. He was given adequate antibiotics to treat the isolated organism Escherichia coli (E. coli), but his pneumonia persisted. After positive tests for an IFI, he was given antifungal medications as well. He failed to improve and finally gave into his illness.

Keywords

• cirrhosis
• jaundice
• non resolving pneumonia
• tuberculosis