Rotor’s syndrome

Differentiating between syndromes possible but clinically unnecessary, due to their

benign nature

Causes of elevation of both conjugated and unconjugated bilirubin (percent of

conjugated bilirubin usually >50%)

Hepatocellular diseases

Viral hepatitis

Hepatitis A, B, C, D and E

Epstein-Barr virus (EBV)

Cytomegalovirus (CMV)

Herpes simplex

Drug Toxicity

Classified as either predictable or unpredictable

Predictable reactions are dose-dependent and affect all patients who ingest toxic dose;
classic example is acetaminophen toxicity

Unpredictable or idiosyncratic drug reactions are not dose-dependent and occur in few
patients

Many drugs can cause idiosyncratic hepatic injury

Environmental toxins include

Industrial chemicals such as vinyl chloride

Herbal preparations containing pyrrolizidine alkaloids (Jamaican bush tea) and kava
kava