Obstructive jaundice is a common  health problem with various complications including ‎liver dysfunction as well as systemic complications. Proper treatment of the underlying ‎etiology  should be the primary goal in management. However, different therapeutic ‎approaches have been tried in lowering the bilirubin serum levels when treatment of the ‎underlying cause is not feasible or unsatisfactory. These approaches include ‎extracorporeal liver support (e.g. molecular adsorbent recirculating system (MARS), ‎plasma exchange,  and charcoal. To the best of our knowledge, this is the first case of ‎marked hyperbilirubinemia that was successfully managed with combined ERCP and  ‎plasma ultrafiltration‏ ‏‎. This is a ‎case of acute suppurative cholangitis following cholethlisiasis treated by combined ‎biliary drainage with ERCP and ultrafiltration and although this exceptional high serum ‎bilirubin and impaired renal function, the patient  recovered..