The provocation test with IV nicotinic acid is positive and produces further rise in the serum bilirubin levels. What is the most likely dx?


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A young male whose sclera was noted to be yellow by his colleagues has a hx of taking OTC drugs for some pain. Tests showed raised bilirubin, ALT and AST normal. The provocation test with IV nicotinic acid is positive and produces further rise in the serum bilirubin levels. What is the most likely dx?

a. Acute hepatitis

b. Drug hypersensitivity

c. Gilberts syndrome

d. Acute pancreatitis

Ans. The key is C. Gilbert’s syndrome. [Only bilirubin is increased but not the liver enzymes. Also positive nicotinic acid provocation test is in its favour].