title: Interplay of co-inherited diseases can turn benign syndromes in a deadly combination: haemoglobinopathy and bilirubin transport disorder.
abstract: We present a case about a 25-year-old male patient suffering from a rare genetic disorder called Mizuho haemoglobin. He was admitted to the Intensive Care Unit with acute liver and renal failure. During admission he also developed a cardiac tamponade twice. Finally he received a liver transplantation. Hereafter the patient stabilised and his liver and renal functions improved. His symptoms could not be explained solely by his known disease. After searching the literature, similarities between his symptoms and a rare complication of sickle cell disease were found. Molecular diagnostics showed that the patient also suffered from Gilbert's syndrome. Due to his chronic haemolysis, symptoms of this other disease were masked. This stresses the importance of always looking for other causes if symptoms or changes cannot be explained by a known rare disorder.
authors.affiliation: Departments of Critical Care,Emergency Medicine, University Medical Center Groningen, University of Groningen, the Netherlands.
authors.forename: T M
authors.initials: TM
authors.lastname: Stolmeijer
authors.forename: A P
authors.initials: AP
authors.lastname: van der Berg
authors.forename: J
authors.initials: J
authors.lastname: Koeze
authors.forename: A S H
authors.initials: AS
authors.lastname: Gouw
authors.forename: F N
authors.initials: FN
authors.lastname: Croles
authors.forename: E
authors.initials: E
authors.lastname: Sieders
authors.forename: J G
authors.initials: JG
authors.lastname: Zijlstra
mesh_terms: D000328:Adult; D001663:Bilirubin / Q000097:blood; D002305:Cardiac Tamponade; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002780:Cholestasis, Intrahepatic / Q000175:diagnosis*; D004452:Echocardiography; D005878:Gilbert Disease / Q000175:diagnosis* / Q000235:genetics / Q000601:surgery; D006455:Hemoglobins, Abnormal / Q000235:genetics*; D006461:Hemolysis; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D020641:Polymorphism, Single Nucleotide; D051437:Renal Insufficiency / Q000175:diagnosis* / Q000235:genetics / Q000601:surgery
chemical_list: D006455:Hemoglobins, Abnormal; C066864:hemoglobin Mizuho; D001663:Bilirubin