Let's move on to a next case,
A 30-year-old man with no past
medical history is seen in clinic
for intermittent yellowing of his eyes.
He currently feels well with no complaints.
Two weeks ago, he noticed his
eyes turn yellow for a few days.
He had a seasonal cold virus at that time.
It resolved without any intervention.
Vitals are normal, physical exam is
unremarkable and there is no hepatosplenomegaly.
His labs show a total bilirubin of 2.5
(mg/dL) with direct bilirubin 0.4 (mg/dL).
His CBC, AST, ALT, alkaline phosphatase,
and GGT and Albumin are all normal,
and the peripheral smear is also normal.
So what is the most likely diagnosis?
So, let's review.
He is a young, healthy male, with intermittent
jaundice that occurs during periods of stress
as noted when he had this
occurred during a cold virus.
He has a mild isolated,
But the rest of his lab
studies are fairly normal.
So, that brings us back to our
diagnostic algorithm for hyperbilirubinemia.
We can hone in on the fact as mostly
unconjugated or indirect hyperbilirubinemia
and it's an isolated bilirubin elevation.
So that brings to either hemolysis, Gilbert
Syndrome or Crigler-Najjar Syndrome.
We return to our case at this point.
We also noticed here that he
has a normal peripheral smear.
This indicates that he
has no ongoing hemolysis.
So now, we know our most likely
diagnosis is Gilbert Syndrome.
You might have noticed that
Crigler-Najjar is also on the differential here
but it is a congenital condition, so
usually it would present earlier in life
and would not present at the age of 30.
Thank you very much for your attention.