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A 21-year-old man was referred with haematochezia for 1 month and scleral icterus for 4 days. His history was unremarkable except chronic anaemia. Physical examination showed scleral icterus, pale conjunctivas, and melanosis on his lips, buccal mucosa and fingers (figure 1). Blood test revealed decreased haemoglobin 7.7 g/dl (normal, 12–16) and elevated white cell count 14.1×103/μl (4–10×103). Liver function …
Competing interests None.
Patient consent Obtained.
Ethics approval This study was conducted with the approval of the Ethics Committee of Sir Run Run Shaw Hospital.
Provenance and peer review Not commissioned; not externally peer reviewed.