{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T10:19:05Z","timestamp":1771064345467,"version":"3.50.1"},"reference-count":2,"publisher":"BMJ","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ Case Reports"],"abstract":"<jats:p>A 28-year-old man with hereditary spherocytosis presented with abdominal pain and jaundice. He had severe, mainly conjugated (642\u2005\u03bcmol\/l), hyperbilirubinaemia (1033\u2005\u03bcmol\/l), with elevated liver enzymes: alkaline phosphatase (ALP) (163\u2005IU\/l), \u03b3-glutamyltransferase (gGT) (277\u2005IU\/l) and aspartate transaminase (AST) (358\u2005IU\/l). Abdominal ultrasound and magnetic resonance cholangiopancreatography (MRCP) showed gallstones in the gallbladder but an absence of biliary duct dilation. Liver biopsy was consistent with cholestasis but showed no large duct obstruction. The cause of the cholestasis was unclear, was it a primary intrahepatic pathology or secondary to a posthepatic cause?<\/jats:p><jats:p>He presented with similar symptoms days later with gallstones in the bile duct (choledocholithiasis) and underwent endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy. This report guides one through the assessment of jaundice and serves as an example whereby the diagnosis of a common cause of illness is blurred by an atypical clinical presentation and relevant comorbidities. A diagnosis of benign recurrent intrahepatic cholestasis (BRIC) is also considered.<\/jats:p>","DOI":"10.1136\/bcr-2012-008417","type":"journal-article","created":{"date-parts":[[2013,4,30]],"date-time":"2013-04-30T10:40:28Z","timestamp":1367318428000},"page":"bcr2012008417","source":"Crossref","is-referenced-by-count":3,"title":["A cholestatic diagnostic dilemma"],"prefix":"10.1136","volume":"2013","author":[{"given":"Lukas","family":"Kalinke","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammed","family":"Rashid","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2013,4,30]]},"reference":[{"key":"2025042707463753000_2013.apr30_1.bcr2012008417.1","doi-asserted-by":"crossref","first-page":"482","DOI":"10.3109\/00365521.2011.650191","article-title":"Benign recurrent intrahepatic cholestasis: review and long-term follow-up of five cases","volume":"2013","author":"Folvik","year":"2012","journal-title":"Scand J Gastroenterol"},{"key":"2025042707463753000_2013.apr30_1.bcr2012008417.2","first-page":"237","article-title":"European Association for the Study of the Liver Clinical Practice Guidelines: management of cholestatic liver diseases","volume":"2013","author":"Beuers","year":"2009","journal-title":"J Hepatol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2012-008417","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,27]],"date-time":"2025-04-27T14:46:45Z","timestamp":1745765205000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2012-008417"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,4,30]]},"references-count":2,"alternative-id":["10.1136\/bcr-2012-008417"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2012-008417","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,4,30]]}}}