SHM Converge Scientific Abstract ePoster Gallery-Bilioptysis as a Clue to Critical Illness in Cirrhosis, a Case Report

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This case report describes bilioptysis, the coughing up of bile-stained sputum, as a rare clinical sign in a critically ill patient with decompensated alcoholic cirrhosis, sepsis, and ARDS. Bilioptysis is usually caused by a bronchobiliary fistula, but fewer than 50 cases have been reported overall, and non-fistulous cases are especially uncommon.<br /><br />The patient was a 51-year-old woman with long-standing alcohol use disorder who presented with nausea, vomiting, abdominal pain, jaundice, fever, and hypoxia. She was admitted with decompensated alcoholic cirrhosis and severe community-acquired pneumonia leading to sepsis. Despite broad-spectrum antibiotics, her condition worsened and she required mechanical ventilation and vasopressors. During a prolonged ICU course, bronchoscopy revealed diffuse yellow secretions concerning for bilioptysis, and bile was detected in sputum. No bronchobiliary fistula was identified. She later developed recurrent respiratory failure and MRSA infection, remained unable to be extubated despite antibiotics and steroids, and ultimately required tracheostomy and PEG placement before discharge after two months.<br /><br />The authors argue that bilioptysis in this patient likely reflected severe systemic illness rather than a fistula. They propose that ARDS, sepsis, cirrhosis, and hyperbilirubinemia increased pulmonary capillary permeability, allowing bilirubin to diffuse into the alveoli and airway secretions. This case highlights bilioptysis as a potential “yellow flag” of severe critical illness in patients with advanced liver disease, especially when accompanied by sepsis and ARDS.

Asset Subtitle

Hamza Saifuddin

Meta Tag

Author List April Emmons, Emre Keskin, Hamza Saifuddin, Logan Wallace

Category Clinical Vignettes

Concept Bilioptysis

Concept Bronchobiliary Fistula

Concept Hepatobiliary Disease

Concept Fistula

Concept Acute Respiratory Distress Syndrome

Distinguished Non-Finalist

Presenter Organization Corewell Health

Presenting Author Hamza Saifuddin

Track Adult

Keywords

bilioptysis

bile-stained sputum

decompensated alcoholic cirrhosis

bronchobiliary fistula

sepsis

ARDS

critical illness

hyperbilirubinemia

bronchoscopy

mechanical ventilation

Bilioptysis

Bronchobiliary Fistula

Hepatobiliary Disease

Fistula

Acute Respiratory Distress Syndrome