title: Improvement of serum bilirubin levels after venesection in a patient with Dubin-Johnson syndrome and HCV-positive chronic liver disease.
abstract: Direct-type hyperbilirubinemia in Dubin-Johnson syndrome is due to the genetic dysfunction of multidrug resistance protein 2. However, serum bilirubin levels may fluctuate as a result of acquired conditions. Iron-reduction therapy by venesection, an alternative to interferon, was performed in a 55-year-old male patient with Dubin-Johnson syndrome complicated by hepatitis C virus-positive chronic liver disease and hepatic iron overload. His pretreatment serum total bilirubin was 10.2 mg/dl, with a dominant direct fraction. The treatment induced a significant reduction in serum total bilirubin, although it remained as high as 7.9 mg/dl. A negative correlation between serum total bilirubin and cumulative bled volume suggested that venesection could suppress bilirubin production from aged erythrocytes. The hepatic iron overload was distributed in hepatocyte lysosomes with Dubin-Johnson granules; thus, it seems that iron removal from the lysosomal granules may also help to reduce serum bilirubin. In conclusion, deep jaundice in a patient with Dubin-Johnson syndrome complicated by hepatitis C virus-positive chronic liver disease and iron overload was partially improved by iron-reduction therapy.
authors.affiliation: Department of Medicine, Faculty of Pharmaceutical Sciences of Hokuriku University, Ho-3, Kanagawa-machi, 920-1181 Kanazawa, Japan.
authors.forename: Ikuo
authors.initials: I
authors.lastname: Machida
authors.forename: Shinya
authors.initials: S
authors.lastname: Wakusawa
authors.forename: Hisao
authors.initials: H
authors.lastname: Hayashi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Suzuki
authors.forename: Motoyoshi
authors.initials: M
authors.lastname: Yano
mesh_terms: D001663:Bilirubin / Q000097:blood*; D022781:Hepatocytes / Q000378:metabolism; D006801:Humans; D019190:Iron Overload / Q000601:surgery; D007566:Jaundice, Chronic Idiopathic / Q000097:blood / Q000601:surgery*; D008107:Liver Diseases / Q000235:genetics; D008247:Lysosomes / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D018962:Phlebotomy; D012367:RNA, Viral / Q000032:analysis; D012709:Serum Albumin / Q000032:analysis
chemical_list: D012367:RNA, Viral; D012709:Serum Albumin; D001663:Bilirubin