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This case report details a 30-year-old man with fatigue, anorexia, and yellowish urine, whose initial presentation involved abnormal bilirubin metabolism. Imaging showed dilated lymphatic vessels around the intrahepatic portal vein without extrahepatic obstruction. Marked hyperbilirubinemia persisted with negative viral and autoimmune evaluations. Glucocorticoid therapy improved jaundice rapidly, with normalization of laboratory indicators and regression of CT findings, supporting glucocorticoids as an option when immune-mediated causes are suspected.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/intrahepatic-lymphedema-presenting-with-abnormal-bilirubin-metabolism-as-the-initial-manifestation-case-report/452689/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/intrahepatic-lymphedema-presenting-with-abnormal-bilirubin-metabolism-as-the-initial-manifestation-case-report/452689.png","ImageObject",300,407,{"name":92,"@type":93},"anakgang17","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":44},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What symptoms and initial findings led to suspicion in this case?","Question",{"text":112,"@type":113},"A 30-year-old man presented with fatigue, anorexia, and yellowish urine for 3 days. Examination showed mild generalized jaundice, and laboratory tests revealed marked elevations in total, direct, and indirect bilirubin.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How were common causes of hyperbilirubinemia evaluated?",{"text":117,"@type":113},"Viral hepatitis markers and autoimmune antibody panels were negative. CT showed dilated lymphatic vessels around the intrahepatic portal vein without extrahepatic biliary obstruction or cardiac dysfunction.",{"name":119,"@type":110,"acceptedAnswer":120},"What treatment was used and what was the outcome?",{"text":121,"@type":113},"Intravenous methylprednisolone sodium succinate was initiated as exploratory treatment. Jaundice improved within days, bilirubin levels decreased substantially by day 8, and by 14 days biochemical indicators normalized with resolved CT abnormalities; liver biopsy was not performed due to refusal and the rapid response.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},452689,1790812350,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":44,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":29,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},962090883568,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","ACG CASE REPORTS JOURNAL  \nCASE REPORT | LIVER  \nIntrahepatic Lymphedema Presenting With Abnormal Bilirubin Metabolism as the Initial Manifestation  \nJingyao Li, MD 1 , Xiangyun Li, MD2 , and Jing Hao, MD2  \n1 Department of Hepatology, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, Hebei Province, P. R. China 2Department of Hepatobiliary Surgery, Xingtai People ’s Hospital, Xingtai, Hebei Province, P. R. China  \nABSTRACT  \nIntrahepatic lymphedema isa rare condition usually associated with hepatobiliary diseases, cardiogenic factors, pancreatic disorders, or malignant lymph node lesions. This report describes a unique case of intrahepatic lymphedema presenting with abnormal bilirubin metabolism as the initial manifestation, with no identical cases identified in the China National Knowledge Infrastructure (CNKI), Wanfang Database, or PubMed. The patient was a 30-year-old Chinese man admitted due to fatigue, anorexia, and yellowish urine for 3 days. Physical examination revealed mild generalized jaundice without hepatosplenomegaly or signs ofchronic liver disease. Laboratory tests showed marked elevation of total bilirubin (347.1 mmol/L), direct bilirubin (241.7 mmol/L), and indirect bilirubin (105.4 mmol/L), while viral hepatitis markers (Hepatitis B Virus DNA, Hepatitis C Virus RNA, Human Immunodeficiency Virus RNA) and autoimmune antibody panels were negative. Abdominal computed tomography (CT) demonstrated dilated lymphatic vessels around the intrahepatic portal vein without extrahepatic biliary obstruction or cardiac dysfunction. Intravenous methylprednisolone sodium succinate (40 mg/d) was initiated as exploratory treatment since autoimmune hepatitis could not be excluded. Jaundice improved significantly after 4 days, with the dose reduced to 20 mg/d. By day 8 of treatment, total bilirubin decreased to 112 mmol/L and liver CT showed regression of lymphatic dilation. At the 14-day follow-up, all biochemical indicators had normalized and CT abnormalities resolved; liver biopsy was not performed due to the patient’s refusal and rapid clinical response to glucocorticoids. This case suggests that exploratory treatment with glucocorticoids (e.g., methylprednisolone sodium succinate) may be effective for patients with unexplained intrahepatic lymphedema and abnormal bilirubin metabolism, especially when an immune-mediated etiology is suspected.  \nKEYWORDS: intrahepatic lymphedema; bilirubin metabolism disorder; methylprednisolone sodium succinate; portal vein; case report ABBREVIATIONS: ALB-s, albumin; ALT, alanine glutathione transferase; APTT, activated partial prothrombin time; AST, aspartate aminotransferase; CL, serum chlorine; CNKI, China National Knowledge Infrastructure; CREA, creatinine (enzymatic); CRP, C reactive protein;  \nDBIL, direct bilirubin; Fib, fibrinogen; GLB-s, globulin; HBCC, Hebei Provincial Hospital of Traditional Chinese Medicine Guidelines (Inferred from context, as per ethical guidelines reference); HBV-DNA, hepatitis B virus qualitative monitoring; HCT, hematocrit; HCV-RNA, hepatitis C virus qualitative detection; HGB, hemoglobin; HIV-RNA, human immunodeficiency virus qualitative detection; IBIL, indirect bilirubin; K, serum potassium; MCV, mean corpuscular volume; Na, serum sodium; PLT, platelet; PT, prothrombin time; RBC, red blood cell; TBIL, total bilirubin; TP, total protein; UNC45A, Unc-45 myosin chaperone A; UREA, urea; WBC, white blood cell  \nINTRODUCTION  \nThe lymphatic system consists of highly permeable interstitial capillaries that transport lymph (containing cellular proteins, lymphocytes, and lipoproteins) . It plays a pivotal role in interstitial fluid reabsorption, immune cell trafficking, and lipid transport, thereby maintaining tissue homeostasis.1–4 The liver is the largest lymph-producing organ; hepatic lymphatic vessels facilitate the clearance of proteins, cholesterol, and immune infiltrates, which is critical for preserving normal liver function.5 Impaired lymp","cbCaib7vRd7k7jYq","https://ap.wps.com/l/cbCaib7vRd7k7jYq","pdf",475215,"English","# Introduction\n# Case Report\n## Clinical history and physical examination","[{\"question\":\"What symptoms and initial findings led to suspicion in this case?\",\"answer\":\"A 30-year-old man presented with fatigue, anorexia, and yellowish urine for 3 days. Examination showed mild generalized jaundice, and laboratory tests revealed marked elevations in total, direct, and indirect bilirubin.\"},{\"question\":\"How were common causes of hyperbilirubinemia evaluated?\",\"answer\":\"Viral hepatitis markers and autoimmune antibody panels were negative. CT showed dilated lymphatic vessels around the intrahepatic portal vein without extrahepatic biliary obstruction or cardiac dysfunction.\"},{\"question\":\"What treatment was used and what was the outcome?\",\"answer\":\"Intravenous methylprednisolone sodium succinate was initiated as exploratory treatment. Jaundice improved within days, bilirubin levels decreased substantially by day 8, and by 14 days biochemical indicators normalized with resolved CT abnormalities; liver biopsy was not performed due to refusal and the rapid response.\"}]","Intrahepatic Lymphedema Presenting With Abnormal Bilirubin Metabolism as the Initial Manifestation - Case Report | PDF",1790737576,15]