Unconjugated hyperbilirubinemia in chronic persistent hepatitis.

We studied a young man with persistent elevation of transaminases and indirect bilirubin following acute viral hepatitis. Liver biopsy showed chronic persistent hepatitis, and clinical evaluation was otherwise negative for significant liver disease. The indirect-reacting serum bilirubin rose after both caloric restriction and intravenous nicotinic acid, responses believed by some to be characteristic of Gilbert's syndrome. Fasting and postprandial serum bile acid conjugates were not elevated. These results suggest that "Gilbert's-like" aberrations in bilirubin metabolism may be part of the spectrum of chronic persistent hepatitis.