Если крапивница случается на фоне повышенного содержания билирубина она может выглядеть так:
у пациентки была гипербилирубинемия (уровень прямого билирубина 7,5 мг на децилитр [128 мкмоль на литр]; общий уровень билирубина, 8,4 мг на децилитр [144 мкмоль на литр]) и повышенный уровень аминотрансферазы.
[Spoiler (click to open)]A 43-year-old woman presented to the hospital after 5 days of itchy, diffusely distributed, evanescent lesions. Ductal carcinoma of the breast had been diagnosed 11 years earlier; despite breast-conserving surgery, radiation, and several rounds of chemotherapy, metastatic disease to the liver and bone had developed. Physical examination revealed diffuse, large, edematous plaques that were yellow with an erythematous edge. Blood testing revealed that the patient had hyperbilirubinemia (direct bilirubin level, 7.5 mg per deciliter [128 μmol per liter]; total bilirubin level, 8.4 mg per deciliter [144 μmol per liter]) and elevated aminotransferase levels. A skin-biopsy specimen revealed edema, and Hall's staining of the specimen for bilirubin revealed focal deposits of olive-green crystals. Yellow urticaria was diagnosed. In a patient with jaundice, the edema fluid associated with urticaria may appear yellow owing to the high bilirubin level. Although the urticarial lesions were treated effectively with antihistamines, the patient died during the hospitalization because of progression of the underlying breast cancer.
Basilio Narváez-Moreno, M.D.
José Juan Pereyra-Rodríguez, Ph.D.
University Hospital Virgen del Rocio, Seville, Spain
Крепкого здоровья!
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