Abstract

AN UNUSUAL PRESENTATION OF ICTERUS DURING SAMSARJANA KRAMA FOLLOWING VIRECHANA: A CASE REPORT

Dr. Priyanka Kalase, Dr. Vrushali Swami

Abstract

Background: Urticaria (Shitpitta) is an Ayurvedic disorder characterised by recurrent episodes of itching, erythema, and skin eruptions resulting from vitiation of Doshas, predominantly Pitta and Vata. Virechana Karma is considered the principal Panchakarma therapy for the management of Pitta-predominant disorders. Case Presentation: A 20-year-old female patient presented with chronic, recurrent complaints of Kandu (itching), Araktavarnatā (erythematous discolouration), and Twak Maṇḍalotpatti (skin eruptions), diagnosed as Shitpitta. Considering the predominance of Pitta Dosha, Virechana Karma was planned. Detailed pre-procedural assessment revealed no contraindications or complications. Intervention: The patient underwent Dipana–Pachana followed by Snehapāna in escalating doses until Samyak Snigdha Lakṣaṇas were achieved. Subsequently, Virechana Karma was performed successfully, resulting in Madhyama Shuddhi with classical Vega and no immediate adverse events. Thereafter, Samsarjana Krama was administered according to classical guidelines. Outcome: During the post-procedural period, the patient developed mild icterus characterised by yellowish discolouration of the skin and sclera, accompanied by generalised weakness. No associated symptoms such as abdominal pain, nausea, vomiting, anorexia, or fever were observed. Further evaluation revealed a history of intermittent episodes of yellowish discolouration of the skin, indicating an underlying latent hepatic susceptibility. Conclusion: The clinical presentation was comparable to Gilbert syndrome, in which intermittent unconjugated hyperbilirubinemia manifests during physiological stress. This case highlights the importance of thorough history taking and vigilant post-procedural monitoring during Panchakarma therapies, particularly in individuals with an underlying predisposition to hepatic dysfunction.

Keywords: Shitpitta, Urticaria, Virechana Karma, Panchakarma, Mild Icterus, Hyperbilirubinemia, Gilbert Syndrome, Case Report, Ayurveda.