Patient History:
A 14-year-old Pakistani boy, admitted to a local hospital for five days,
presented with progressively worsening fever and deepening jaundice for
the last two months. On further inquiry, the patient had scleral icterus
for the past seven years, which further exacerbated his hospital stay of
five days. When the patient presented with yellowish discoloration of
the sclera seven years ago, he was diagnosed with viral Hepatitis A and
Hepatitis E. The patient was given symptomatic treatment and
subsequently discharged. Although it never completely subsided, the
patient’s scleral yellowish hue got milder in response to the treatment.
The patient received a particular non-invasive spiritual therapy
throughout his illness. However, the presentation of scleral pallor of
the eyes prevailed with no significant worsening of symptoms until the
most recent hospital admission. During his recent stay at the hospital,
the yellowish hue on the sclera increased. Over the past two months, the
patient developed pyrexia, which was initially of low grade, progressed
to high grade, and was found to be of intermittent nature. The fever was
relieved by the intake of antipyretics.
Physical Examination:
The patient was a young male belonging to a south Asian origin. He was 4
feet and 3 inches tall and weighed 38 kg. On inspection, the patient was
ill-looking and had an undocumented weight loss. The patient seemed well
oriented to time, place, and person at the time of examination. He was
normotensive and had a pulse rate of 98 beats/minute. His pulse had a
regularly regular rhythm. The patient’s respiratory rate was 20
breaths/minute, and his temperature was recorded to be 101 degrees
Fahrenheit. His skin was deeply icteric. Koilonychia on upper extremity
digital examination and conjunctival pallor indicated anemia. Apart from
conjunctival pallor, there was deep scleral icterus, whereas any
evidence of Kayser–Fleischer rings was masked due to deep discoloration
on examination of the eyes (Figure 1) . Respiratory examination
revealed that the patient was tachypneic on inspection.