A patient presents with unconjugated hyperbilirubinemia and presence of urobilinogen in urine. Which amongst the following is the least likely diagnosis?
Hemolytic jaundice
Crigler Najjar syndrome
Gilbe's syndrome
Dubin Johnson syndrome
Dubin Johnson syndrome is a beingn rare disorder characterized by conjugated hyperbilirubinemia. The degree of hyperbilirubinemia increase during illness, pregnancy and with the use of oral contraceptive pills. Physical examination shows jaundice sometimes hepatospleenomegaly. Investigations: shows elevated serum bilirubin levels. Other routine tests are normal. Cardinal feature of DJS is accumulation of dark coarsely granular pigment within the lysosomes of centrilobular hepatocytes. This gives a gross black appearance to the liver. This pigment is derived from epinephrine metabolites that are not excreted. Ref: Harrison's principles of internal medicine 18th edition, Chapter 303.