Abstract
Rotor syndrome is a rare, benign and inherited cause of chronic hyperbilirubinemia. Several studies have provided evidence that elevated bilirubin level has cardioprotective benefits with reduction in the severity of coronary artery disease (CAD). However, current evidence is inconclusive regarding the protective effect of bilirubin on CAD. A57-year-old male with a history of chronic jaundice since childhood, presents tothe Gastroenterohepatology clinic ofDr. Soetomo Hospital with CAD Triple Vessel Dissease pro urgent CABG. Physical examination revealed icteric sclerae without hepatosplenomegaly. The patient suffered from hypertension and dyslipidemia for 10 years. He had an elevated total bilirubin level of 5.92 mg/dL with a direct bilirubin of 4.02 mg/dL (68% of total bilirubin), with normal aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) levels. An evaluation for chronic liver disease revealed negative hepatitis serologies, anti-smooth muscle antibody, antinuclear antibodyand antimitochondrial antibody as well as normal. BSP clearance test results show a delay. Abdomencomputed tomography (CT) scan showed normal without any biliary dilation. The liver biopsy was normal with no hepatocellular pigment. A patient with chronic jaundice symptoms has been reported who is later diagnosed as Rotor syndrome. The patient also suffered from CAD. The protective effects of bilirubin are not proven in this patients.
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