Autoimmune progesterone dermatitis as a clue to refractory jaundice in a young woman

Abstract

A lady in her 20s presented to the emergency department with profound icterus which had not resolved with standard hepato‐protective measures (ursodeoxycholic acid, cholestyramine, N‐acetyl cysteine). She had nausea, malaise and intense pruritus all over the body. Drug history revealed the intake of progesterone (norethisterone acetate, 5mg/day) for menorrhagia one week prior to the development of the icterus. Blood investigations revealed raised total bilirubin=24.4mg/dL, (direct =23.9mg/dL) and serum alkaline phosphatase=206 IU/L, (44‐147) with normal liver enzyme levels.