Delayed resolution of jaundice in the arm of a patient with impaired lymphatic drainage: a case report.

A 40-year-old woman, 6 years after mastectomy, lymph node dissection, and locoregional radiation, presented with hepatic metastases, pruritus, and jaundice. Physical examination revealed uniformly jaundiced skin and no arm lymphedema. Ultrasonography confirmed progressive hepatic metastases with no evidence of intrahepatic or extrahepatic biliary dilatation. Eight weeks after starting chemotherapy, her pruritus and jaundice were markedly improved, but the jaundice on the skin of her left arm was substantially slower to clear than the other skin areas. With further therapy, serum bilirubin normalized and her left arm jaundice completely resolved. We hypothesize that the delayed resolution of jaundice on her left arm resulted from impaired lymphatic drainage after left axillary lymph node dissection and irradiation, and conclude that lymphatic drainage might play a key role in the transport and clearance of bilirubin and related pigments from peripheral tissues.