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- W2088244232 abstract "A 50-year-old man presented with amoxicillin-induced cholestatic liver injury with resultant dialysis-dependent acute kidney injury. Total bilirubin ranged from 30 to 33 mg/dL, AST/ALT 200 to 400 U/L, and alkaline phosphatase from 3,000 to 4,000 U/L.Because of fever and delirium, lumbar puncture (LP) was performed on hospital day 30 after normal head imaging. Moderate xanthochromia was immediately visualized after a non-traumatic tap. Analysis revealed RBC 1/cu mm, WBC 1/cu mm, minimally elevated protein (50 mg/dL), and normal glucose (82 mg/dL).Xanthochromia, “blond color” in Greek,1 is caused by pigment in the cerebral spinal fluid (CSF). Xanthochromia is classically associated with subarachnoid hemorrhage (SAH): red blood cells lyse within hours and are metabolized from oxyhemoglobin (pink) to bilirubin (yellow). Xanthochromia is present in >90 % of patients with a SAH within 12 h of onset,1–3 but can also occur with increased CSF protein (≥150 mg/dL) due to bilirubin binding, traumatic LP with delayed analysis, and serum hyperbilirubinemia (>10–15 mg/dL), which was the most likely cause in this case.1,2,4 Literature suggests an association between CSF and serum bilirubin levels but not the duration of hyperbilirubinemia.5 Spectrophotometry can be used to identify bilirubin with or without oxyhemoglobin.3,6,7 However, xanthochromia should continue to raise concern for SAH in appropriate clinical scenarios (Fig. 1).Fig. 1CSF vials after lumbar puncture, with the hallmark blond color of xanthochromia." @default.
- W2088244232 created "2016-06-24" @default.
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- W2088244232 date "2015-02-10" @default.
- W2088244232 modified "2023-10-05" @default.
- W2088244232 title "“If You Prick Us, Do We Not Bleed?”: An Uncommon Cause of Xanthochromia" @default.
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- W2088244232 doi "https://doi.org/10.1007/s11606-015-3210-0" @default.
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