Bitot ’s spots and a bilirubin ring

A 16 year-old girl presented with intermittent fever, progressively deepening jaundice for the last 6 weeks, and hematemesis. She presented in grade III hepatic encephalopathy. Eye examination showed Bitot ’s spots (foamy white triangular lesion on temporal conjunctiva) and a bilirubin ring (yellowish green circumferential hue) or pseudo Kayser-Fleischer (KF) ring at the corneo-scleral junction (Figure, A). Magnetic resonance cholangiography showed fusiform dilatation of the extrahepatic biliary sys tem suggestive of type I choledochal cyst.
Source: The Journal of Pediatrics - Category: Pediatrics Authors: Tags: Rediscovering the Physical Exam Source Type: research