A young man with acute generalised jaundice and intermittent epigastric pain

• Published in: Deutsche medizinische Wochenschrift (1946) Vol. 133; no. 4; p. 129
• Main Authors: Walz, B, Riecken, B
• Format: Journal Article
• Language: German
• Published: Germany 01-01-2008
• Subjects: Abdominal Pain; Adult; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Aspirin - adverse effects; Diagnosis, Differential; Germany; Glycogen Storage Disease Type I - diagnosis; Glycogen Storage Disease Type I - ethnology; Glycogen Storage Disease Type I - therapy; Humans; Iraq - ethnology; Jaundice; Male; Germany; Iraq
• ISSN: 1439-4413
• DOI: 10.1055/s-2008-1017486

A 24-year-old Iraqi was admitted to our hospital with acute generalised jaundice and intermittent epigastric pain. His family doctor suspected a viral hepatitis. Two days prior admission the patient had consumed large quantities of alcohol and had subsequently taken analgetic dosages of paracetamol and acetylsalicylic acid.
Besides an otherwise inconspicuous physical examination the laboratory results revealed a distinct hemolysis with macrocytic, hyperchromic anaemia and negative Coombs-test. Indirect bilirubin was initially 25.2 mg/dl, LDH 2367 U/l and reticulocytes 4.4 %; haptoglobin and transferrine levels were correspondingly low. A hemoglobinopathies was excluded by hemoglobin-electrophoresis and a blood-smear. DIAGNOSIS, TREATMENT AND FURTHER COURSE: A glucose-6-phosphate dehydrogenase deficiency (G6PDD) was suspected and subsequently confirmed within three days. Acetylsalicylic acid, the most probable trigger, and other possible triggers like ciprofloxacin, metamizole, and cotrimoxazole were avoided; the jaundice faded rapidly, and the laboratory-parameters almost normalized.
In patients with acute jaundice, abdominal pain, and signs of hemolysis collection of accurate anamnestic information is essential. In case of a young male with positive family-history, applicable ethnical origin, and intake of potential oxidative stressors a G6PDD should be suspected and result in requesting specific tests. Analgetic therapy with metamizole must be strictly avoided.