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].