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Yellow Urticaria

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

A man in his 70s presented to the hospital with dark urine in the setting of increased acetaminophen use. Hours after receiving a computed tomography scan with iodine-based contrast, he developed a pruritic rash. A physical examination revealed scleral icterus, jaundice, and well-circumscribed, bright yellow papules and plaques on his lateral abdomen (Figure). Laboratory findings included an alkaline phosphatase level of 903 U/L (to convert to μkat/L, multiply by 0.0167), total bilirubin level of 13.3 mg/dL (to convert to μmol/L, multiply by 17.104), direct bilirubin level of 11.6 mg/dL, alanine transaminase level of 124 U/L, and aspartate transaminase level of 145 U/L. A biopsy of the liver revealed findings consistent with drug-induced liver injury. His rash responded to treatment with antihistamines, and his transaminase levels improved with cessation of acetaminophen use.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: R. Matthew McLarney, MD, Three Cooper Plaza, Ste 504, Camden, NJ 08103 (matt.mclarney@gmail.com).

Published Online: April 6, 2022. doi:10.1001/jamadermatol.2022.0597

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

References
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2.
Mendes  L , João  GAP , Oliveira  LM .  Yellow urticaria in a patient on prophylactic antiretroviral therapy.   An Bras Dermatol. 2018;93(4):618-619. doi:10.1590/abd1806-4841.20187573PubMedGoogle ScholarCrossref
3.
Combalia  A , Fustà  X , Guilabert  A , Mascaró  JM  Jr , Estrach  T .  Hyperbilirubinaemia: the common denominator of yellow urticaria.   J Eur Acad Dermatol Venereol. 2017;31(12):e533. doi:10.1111/jdv.14397 PubMedGoogle ScholarCrossref
4.
Ackerman  M , Esteve  E , Potier  P , Finon  A .  Two cases of yellow urticaria revealing acute lithiasic biliary disease.   Australas J Dermatol. 2021;62(2):e326-e327. doi:10.1111/ajd.13496 PubMedGoogle ScholarCrossref
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