Hemolytic jaundice caused by rebamipide

Abstract

A 64‑year‑old male patient underwent gastroscopy for dizziness and bloody stool, showing bleeding gastric ulcer. After gastroscopy, he was treated with pantoprazole sodium for injection, Danggui Buxue oral liquid (当归补血口服液), and symptomatic and supportive treatments. The patient was gradually improved and had no hematemesis and melena stool. Laboratory tests showed total bilirubin (TBil) 9.9 μmol/l and direct bilirubin (DBil) 4.6 mmol/L. Four days later, rebamipide 0.1 g thrice daily orally was added. The next morning, the patient had soy sauce colored urine and yellowish skin and sclera. Laboratory tests showed TBil 81.4 μmol/l, DBil 8.9 mmol/L, and lactate dehydrogenase (LDH) 1 448 U/L. Hemolytic jaundice was considered, which might be related to rebamipide. Then rebamipide was stopped, the other drugs were continued, and treatments such as alkalization of urine (sodium bicarbonate 1 g thrice daily by mouth) and rehydration were given. Two days later, the urine color in the patient became lighter, the yellowish skin and sclera subsided, and laboratory tests showed TBil 43.1 μmol/l, DBil 11.2 mmol/L, and LDH 842 U/L.