Persistent intrahepatic cholestasis secondary to multiple etiologies: a case report.

Intrahepatic cholestasis may arise from multiple etiologies, but it is particularly challenging to identify its primary etiology, especially when several potential contributors overlap and the disease itself progresses over time. Herein, we report a 42-year-old man with adult-onset Still's disease (AOSD) who developed persistent severe intrahepatic cholestasis. At early stage of this disease, intrahepatic cholestasis was attributed to severe liver injury secondary to AOSD and drug-induced liver injury. Subsequently, sepsis developed, which might be associated with the use of glucocorticoids and contamination of central venous catheter, and aggravated intrahepatic cholestasis. Finally, the patient's condition was gradually improved after catheter removal and targeted antibiotic therapy. This case highlights the importance of etiological reassessment in the management of persistent intrahepatic cholestasis.