A Masquerading Case of Jaundice

Background and Aim: Drug induced liver injury (DILI) is a very common cause of jaundice in our country. In India, ATT (46.4 %), Complementary Alternative medicine (13.9 %) Anti-epileptics (8.1 are the most culprits for same. DILI can present with varied manifestations be great masquerader. Case Report: We case 26-year old female, complaints abdominal pain 4 months, itching all over body 3 months. The patient was evaluated private setup diagnosed Choledocholithiasis Cholelithiasis on basis MRCP; subjected to ERCP after 2 weeks CBD stenting done. However worsened she then referred hospital. On admission severely icteric had severe excoriations scratch marks body. Per examination revealed hepatomegaly rest systemic normal. Repeat MRCP done, which didnt reveal any biliary obstruction or stent situ. Hepatitis serology, AIH panel, IgG total, AMA-M2 celiac serologies were negative. Patient biopsy mixed hepatic cholestatic pattern zone neutrophilic, eosinophilic infiltration rosettes, possibility drug injury. retrospection, it found that has been using several complementary alternative medications her eczema, weight gain irregular menses. She started steroids antihistaminics, naloxone, cholestyramine pruritus. Her began improve normalized about 1.5 off since months not relapsed, skin lesion have improved doing well. Conclusion: should always kept as an important differential jaundice, even absence history intake.