Idiopathic cholestatic jaundice may be a paraneoplastic manifestation of underlying malignancy: a case of prostate cancer.

A 68-year-old male was admitted to our hospital because of jaundice. Laboratory examinations revealed elevated total bilirubin (23.4 mg/dl) and hepatobiliary enzymes levels. Abdominal ultrasonography and computed tomography showed no abnormal finding in the liver and biliary ducts. Abdominal imaging examinations revealed a prostate tumor, and paraaortic and iliac lymph nodes enlargement. An elevated prostate-specific antigen (PSA) level of 15,018.0 ng/ml, followed by a positive prostate biopsy, confirmed prostate cancer. Histological examination of the liver biopsy showed non-specific inflammation of the portal area and sinusoid. We regarded the cholestatic jaundice as a paraneoplastic manifestation of the prostate cancer because of parallel dramatic decline of total bilirubin, hepatobiliary enzymes, and PSA levels after the initiation of anti-androgen treatment to the prostate cancer. Paraneoplastic syndrome should be included in the differential diagnosis of idiopathic cholestasis.