Bilioptysis associated with ARDS and sepsis: A rare presentation and review of the literature

Bilioptysis or the presence of bilirubin in sputum or bronchial secretions is thought to be secondary to the presence of a broncho-biliary fistula. Bilioptysis is not well described in; literature, likely due to the rare nature of its incidence. There have been reports of bilioptysis secondary to other conditions such as hyperbilirubinaemia associated with liver cirrhosis, alcohol-related hepatitis, and haemolysis associated with sickle cell disease without demonstrable evidence of the presence of a fistula . The clinical implications of bilioptysis as well as the effect on the prognosis of the patient are still unclear and warrant further investigation. Here we present the first case of bilioptysis demonstrated on a bronchoalveolar aspirate (BAL) fluid sample in a patient with a brain tumour and possible associated neurogenic ARDS and sepsis.