Paraneoplastic presentation of cholestatic jaundice in renal cell carcinoma.

A 46-year-old female was admitted to the hospital with jaundice and pruritus. The patient had no previous history of liver or biliary disease. She had no reported any drug use nor had she any history of cigarette smoking or drinking alcohol. In the physical exam, she had icterus in the sclera of her eyes, and no pathologic exam finding was observed other than mild painless hepatomegaly. There were no palpable lymph nodes, splenomegaly, or ascites. Laboratory findings revealed: hemoglobin 11.6 g/dL, white blood cells 7200/μL, platelets 368,000/ μL, aspartate aminotransferase (AST) 103 IU/L, alanine aminotransferase (ALT) 77 IU/L, gamma-glutamyl transpeptidase (γ-GT) 122 IU/L, alkaline phosphatase (ALP) 183 IU/L, total bilirubin 8.9 mg/dL, conjugated bilirubin 6.3 mg/dL, and albumin 3.3 mg/dL. Thyroid function tests, blood urea nitrogen, and serum creatinine were all within normal limits.