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A 67-year-old man with a history of alcoholic cirrhosis presented with acute abdominal pain. His total bilirubin was 43.8 mg/dL and fractionated to a direct bilirubin of 32.7 mg/dL. A warm agglutinin IgG1 antibody was positive, and abdominal magnetic resonance imaging detected an obstructing stone at the level of the sphincter of Oddi. Two pigmented gallstones were removed by endoscopic retrograde cholangiopancreatography. His total bilirubin decreased to 24.6 mg/dL the following day, and he was initiated on 20 mg of prednisone for his autoantibody.

Multifactorial jaundice and pigmented choledocholithiasis secondary to warm autoimmune hemolytic anemia and alcoholic cirrhosis