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  1. Fulltext Probable hepatic tuberculosis masquerading as Klatskin tumour in an immunocompetent patient
    Hanafiah M, Alhabshi SM, Bag T, Low SF
    BMJ Case Rep, 2013;2013.
    PMID: 24343799 DOI: 10.1136/bcr-2013-010262
    A 55-year-old immunocompetent woman was presented with features of obstructive jaundice and a clinicoradiological picture suggestive of a hilar cholangiocarcinoma (Klatskin tumour). However, caseating granulomatous lesion associated with miliary nodules were revealed intraoperatively. The lesion responded to standard antituberculous therapy. This unusual presentation highlights the considerable diagnostic challenge in such case.
    Matched MeSH terms: Jaundice, Obstructive/diagnosis*
  2. A Case Report on Cholestatic Jaundice Secondary to Adverse Effect of Phaleria macrocarpa (Mahkota Dewa)
    Rahim MFA, Payus AO
    Acta Med Indones, 2019 Oct;51(4):344-347.
    PMID: 32041919
    Drug induced cholestatic liver injury can posed a great diagnostic difficulty as a result of its long non-exhaustive list of potential offending causes which can be either prescribed or over-the-counter medications, such as medicinal herbs and remedies. Phaleria macrocarpa, or more commonly known as the 'God's crown' by the local people of South East Asia, is not listed as one of the causes. This medicinal plant extract has been increasingly used for traditional treatment for various ailments. Here, we report a case of a young man who has no known medical illness presented with cholestatic pattern of liver injury which caused by chronic ingestion of Phaleria macrocarpa. The objective of this case report is to share the uncommon side effect of taking this traditional product which may have been under-reported due to the unknown effect.
    Matched MeSH terms: Jaundice, Obstructive/diagnosis*
  3. A prospective multicentre study evaluating the performance of the modified simple biliary atresia scoring system in predicting biliary atresia
    Mahat N, Chiang LW, Chen Y, Razak NHA, Abdullah MY, Sanmugam A, et al.
    Pediatr Surg Int, 2024 Aug 27;40(1):244.
    PMID: 39191932 DOI: 10.1007/s00383-024-05830-w
    PURPOSE: Early diagnosis of biliary atresia (BA) is critical for best outcomes, but is challenged by overlapping clinical manifestations with other causes of obstructive jaundice in neonates. We evaluate the performance of the modified Simple BA Scoring System (SBASS) in diagnosing BA.

    METHODS: We performed a prospective, cross-sectional study on infants with cholestatic jaundice (June 2021-December 2022). Modified SBASS scoring was applied and compared to the eventual diagnosis (as per intraoperative cholangiogram (IOC) and liver histopathology). The score (0-6), consists of gall bladder length  0.7(+ 2), gamma-glutamyl transferase (GGT) ≥ 200 U/L (+ 2).

    RESULTS: 73 were included: Fifty-two (71%) had BA. In the non-BA group, 6 (28%) had percutaneous cholangiography (PTC) while 15 (72%) had intraoperative cholangiogram (IOC). At a cut-off of 3, the modified SBASS showed sensitivity of 96.2%, specificity of 61.9% and overall accuracy of 86.3% in diagnosing BA. Area under receiver operating characteristic curve was 0.901. GGT had the highest sensitivity (94.2%), while triangular cord sign showed the highest specificity at 95.2%.

    CONCLUSION: The SBASS provides a bedside, non-invasive scoring system for exclusion of BA in infantile cholestatic jaundice and reduces the likelihood of negative surgical explorations.

    Matched MeSH terms: Jaundice, Obstructive/diagnosis
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