Yellow-eyed man and dromomania: A case of adult-onset psychiatric symptoms in Crigler–Najjar syndrome type II

A 30-year-old man presented with long-standing, treatment-resistant psychiatric symptoms including compulsive wandering, hallucinations, and obsessive behaviors. Physical examination revealed deep yellow sclera present since childhood. Genetic testing identified compound heterozygous mutations in the UGT1A1 gene, confirming Crigler–Najjar syndrome type II. Initiation of phenobarbitone and adjunctive therapy led to a marked reduction in serum bilirubin and clinical symptoms. This case highlights the possibility of bilirubin-induced neurological dysfunction presenting in adulthood as a chronic psychiatric condition.