Exacerbation of Hyperbilirubinemia by Falciparum Malaria in a Patient With Coexisting Gilbert’s Syndrome and Glucose-6-Phosphate Dehydrogenase Deficiency

Gilbert's syndrome and G6PD deficiency are common genetic disorders. They both give rise to unconjugated hyperbilirubinemia through different mechanisms. Falciparum malaria-induced hemolysis is another cause of unconjugated hyperbilirubinemia. We have reported a 51-year-old Asian male who presented with a four-day history of fever and sweating just after a holiday in Kenya. He admitted to not taken malaria prophylaxis while on holiday. Initial investigations revealed that he had falciparum malaria along with co-existing severe G6PD deficiency and Gilbert's syndrome, which we believe, all contributed to an exacerbation of unconjugated hyperbilirubinemia (four-fold rise). He was treated with intravenous fluids, paracetamol and oral artemether/lumefantrine combination therapy. He made a good clinical recovery. After a month, he still exhibited chronic unconjugated hyperbilirubinemia with recurrent elevation in his reticulocyte count but no anaemia, suggesting further episodes of compensated hemolysis. We also discuss the differential diagnosis for unconjugated hyperbilirubinemia in relation to this interesting case.