To highlight the diagnostic challenges of misinterpreting Gilbert syndrome as drug-induced liver injury (DILI) during tuberculosis treatment.
Approach:
Case Presentation: A 22-year-old woman with smear-negative pulmonary tuberculosis developed recurrent elevations in total and indirect bilirubin while transaminase levels remained normal, leading to misinterpretation as DILI.
Genetic Testing: UGT1A1 genetic testing identified variants confirming Gilbert syndrome, which explained the bilirubin elevations.
Key Findings:
Persistent indirect hyperbilirubinemia with normal transaminases in this case indicated Gilbert syndrome rather than DILI.
The misinterpretation of bilirubin levels led to unnecessary interruptions in tuberculosis therapy, delaying effective treatment for over a year.
Recognition of Gilbert syndrome allowed for the continuation of appropriate anti-tuberculosis therapy.
Interpretation:
This case highlights the need to consider Gilbert syndrome as a differential diagnosis when encountering atypical liver function test results during tuberculosis treatment.
Limitations:
This case report is based on a single patient, which limits the generalizability of the findings.
There may be limited awareness of Gilbert syndrome among clinicians treating tuberculosis, potentially leading to similar misdiagnoses.
Conclusion:
Early recognition of Gilbert syndrome through genetic testing can prevent unnecessary treatment interruptions.
