She went to the ER after having jaundice for two months.

By Leah Groth
February 26, 2020
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A new case study published Wednesday in The New England Journal of Medicine examines the condition of a 62-year-old woman who had a biliary cast—or a buildup of bile and other material in the bile ducts—removed from her body following a liver transplant.

The woman reportedly presented to the emergency department after having suffered from jaundice—a condition in which the skin, whites of the eyes, and mucous membranes appear yellow, due to an excess of bilirubin, a yellow chemical found in red blood cells—for two months. The jaundice stared after she underwent orthotopic liver transplantation for primary biliary cirrhosis, an autoimmune disease of the liver.

Lab tests found that the woman did in fact have extremely high bilirubin levels, along with elevated levels of serum alanine aminotransferase, and serum aspartate aminotransferase, both indicators of liver health. Doctors also discovered dilatation (widening) of the lower end of the common bile duct and a filling defect at the upper end of the common bile duct, along with a thinning of the intrahepatic bile duct. 

As the patient's condition continued to worsen, she had to undergo a second orthotopic liver transplantation. However, during the procedure, branch-like biliary casts were found and removed from the upper end of the common bile duct and from the intrahepatic bile duct.

She was ultimately diagnosed with biliary cast syndrome, according to the case study. “Biliary cast syndrome is characterized by the development of casts in the biliary tree after liver transplantation," study authors explain.

A case series published in Endoscopy International Open, delves deeper into the biliary cast syndrome phenomenon, explaining it is a complication of orthotopic liver transplantation that occurs in 4% to 18% of orthotopic liver transplantation recipients. Symptoms can include high fever, jaundice and cholestatic liver enzyme elevation. Like the patient mentioned above, twenty-two percent of patients with biliary cast syndrome require repeat transplants.

Luckily for the patient, after the surgery her jaundice resolved, and subsequent lab tests confirmed she had returned to baseline levels. She was checked again 6 months later, and was still doing well.

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