Case Info - BotMed Application

CaseName

Presentation case 13. Gilbert syndrome

CaseDescription

A 14 year old boy hailing from Bishal Nagar, Kathmandu admitted in Paediatric ward KMCTH with history of yellowish discolouration of sclera for 10 days. There were no other complaints. Urine colour was normal. Child had history of similar illness one year back and also 3 months back, which subsided on its own. For present complaint, child was shown to Ayurvedic doctor who advised restriction of diet including fatty meals. However, mother noticed the deepening of jaundice in sclera without any abnormality in urine colour.

PhysicalExams

Mild jaundice present, but no other abnormal physical findings were evident.

Labs

Normal haemoglobin;
Normal ESR;
Adequate platelets;
Reticulocyte was within normal limit (0.5%);
Peripheral blood picture showed no abnormality including any features of haemolysis
Osmotic fragility - within normal limit;
Liver function tests within normal limit;
The maximum total and indirect serum bilirubin reached were 5.3mg/dl and 4.9mg/dl respectively. 

DDx: possibility of Gilbert syndrome. 
Fasting or provocation test (child kept on 400Kcal/day for 48 hours). 
Serum bilirubin.
Before fasting: Total-1.5 mg/dl; Indirect-0.75 mg/dl;
After 48 hours of fasting: Total-3.61mg/dl; Indirect-2.16 mg/dl;

Urine, stool within normal limits.

ImagingStudies

Chest radiograph within normal limits.

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