Severe Cholestatic Jaundice as the Initial Manifestation of Radiologically Occult Metastatic Prostate Cancer: An Icteric Variant of Stauffer Syndrome.

Stauffer syndrome is a rare paraneoplastic hepatic dysfunction classically associated with renal cell carcinoma and increasingly recognised in association with other malignancies. The icteric variant, characterised by clinically apparent jaundice and marked hyperbilirubinaemia, is particularly uncommon. We report the case of a 75-year-old man who presented with progressive cholestatic jaundice, with total bilirubin levels peaking at approximately 20 mg/dl. An extensive diagnostic workup including laboratory testing, upper gastrointestinal endoscopy, cross-sectional imaging, magnetic resonance cholangiopancreatography and liver biopsy excluded biliary obstruction, hepatic metastasis and primary hepatobiliary disease. Due to the absence of prostate abnormalities on imaging and lack of lower urinary tract symptoms, prostate cancer was not initially suspected. The diagnosis was ultimately established through biopsy of a splenic lesion, which confirmed metastatic prostate adenocarcinoma on immunohistochemistry. Serum prostate-specific antigen was measured only after histological confirmation and was markedly elevated. Following surgical androgen deprivation therapy, there was rapid and sustained improvement in cholestasis, supporting the diagnosis of icteric Stauffer syndrome secondary to prostate cancer. LEARNING POINTS: Severe cholestatic jaundice may represent a paraneoplastic manifestation of occult prostate cancer.Normal biliary imaging, negative endoscopic evaluation and non-specific liver biopsy findings should prompt consideration of paraneoplastic cholestasis.Rapid biochemical improvement following oncologic treatment strongly supports the diagnosis of Stauffer syndrome.