Case Report: Hyperbilirubinemia in Gilbert Syndrome Attenuates Covid-19-Induced Metabolic Disturbances

Gilbert syndrome (GS) is a liver disorder characterized by non-hemolytic unconjugated hyperbilirubinemia. On the other hand, Coronavirus disease 2019 (Covid-19) is a recent viral infectious disease presented as clusters of pneumonia, triggered by the severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2). Little is known on the association between SARS-CoV-2 and GS, despite different studies have recently stated a link between hyperbilirubinemia and SARS-CoV-2 severity. In this case-report study we described a 47-year-old man, a known case of GS since the age of 4, presented to the emergency department with fever (39.8°C), dry cough, dyspnea, headache, myalgia, sweating and jaundice diagnosed with Covid-19-induced pneumonia. Interestingly, GS patient exhibited a rapid clinical recovery and short hospital stay compared to other SARS-CoV-2 positive patient, seeming that hyperbilirubinemia may exert a protective effect of against Covid-19 induced-cardiometabolic disturbances. Data obtained here underlines that the higher resistance against Covid-19 evidenced by the GS patient seems to be due to the antioxidant, anti-inflammatory, and antiviral effects of unconjugated bilirubin.

[1]  Zeming Liu,et al.  Bilirubin Levels as Potential Indicators of Disease Severity in Coronavirus Disease Patients: A Retrospective Cohort Study , 2020, Frontiers in Medicine.

[2]  Y. Jeong,et al.  The Anti-Inflammatory Role of Bilirubin on “Two-Hit” Sepsis Animal Model , 2020, International journal of molecular sciences.

[3]  Steven P. Keller,et al.  Emerging Mechanisms of Pulmonary Vasoconstriction in SARS-CoV-2-Induced Acute Respiratory Distress Syndrome (ARDS) and Potential Therapeutic Targets , 2020, International journal of molecular sciences.

[4]  J. P. de Rivero Vaccari,et al.  The Inflammasome in Times of COVID-19 , 2020, Frontiers in Immunology.

[5]  H. Goyal,et al.  Pulmonary and Extra-Pulmonary Clinical Manifestations of COVID-19 , 2020, Frontiers in Medicine.

[6]  J. Taneera,et al.  Expression Profile of SARS-CoV-2 Host Receptors in Human Pancreatic Islets Revealed Upregulation of ACE2 in Diabetic Donors , 2020, Biology.

[7]  K. Sklinda,et al.  COVID-19 severity scoring systems in radiological imaging – a review , 2020, Polish journal of radiology.

[8]  Kai Yin,et al.  Bilirubin in metabolic syndrome and associated inflammatory diseases: New perspectives. , 2020, Life sciences.

[9]  Hayder M Al-Kuraishy,et al.  Macrolides and COVID-19: An optimum premise , 2020 .

[10]  L. García,et al.  Immune Response, Inflammation, and the Clinical Spectrum of COVID-19 , 2020, Frontiers in Immunology.

[11]  D. Ragab,et al.  The COVID-19 Cytokine Storm; What We Know So Far , 2020, Frontiers in Immunology.

[12]  N. Soudani,et al.  Molecular Insights Into SARS COV-2 Interaction With Cardiovascular Disease: Role of RAAS and MAPK Signaling , 2020, Frontiers in Pharmacology.

[13]  N. Liu,et al.  High rate of increased level of plasma Angiotensin II and its gender difference in COVID-19: an analysis of 55 hospitalized patients with COVID-19 in a single hospital, WuHan, China , 2020, medRxiv.

[14]  M. Lila,et al.  In Vitro Evaluation of a Novel Synthetic Bilirubin Analog as an Antioxidant and Cytoprotective Agent for Pancreatic Islet Transplantation , 2020, Cell transplantation.

[15]  W. Brady,et al.  Cardiovascular complications in COVID-19 , 2020, The American Journal of Emergency Medicine.

[16]  M. Moustaki,et al.  Gilbert syndrome. , 2020, European journal of pediatrics.

[17]  Ji‐Hyun Lee,et al.  Serum bilirubin level is associated with exercise capacity and quality of life in chronic obstructive pulmonary disease , 2019, Respiratory Research.

[18]  Baojian Wu,et al.  Bilirubin alleviates alum-induced peritonitis through inactivation of NLRP3 inflammasome. , 2019, Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie.

[19]  T. Hinds,et al.  Bilirubin, a Cardiometabolic Signaling Molecule , 2018, Hypertension.

[20]  A. Bulmer,et al.  Chronically elevated bilirubin protects from cardiac reperfusion injury in the male Gunn rat , 2017, Acta physiologica.

[21]  R. Tsang,et al.  Oncology Drug Dosing in Gilbert Syndrome Associated with UGT1A1: A Summary of the Literature , 2017, Pharmacotherapy.

[22]  A. Tanaka,et al.  Gilbert Syndrome with Concomitant Hereditary Spherocytosis Presenting with Moderate Unconjugated Hyperbilirubinemia , 2017, Internal medicine.

[23]  HirofumiTomiyama,et al.  Hyperbilirubinemia, Augmentation of Endothelial Function, and Decrease in Oxidative Stress in Gilbert Syndrome , 2012 .

[24]  G. Fadda,et al.  Bilirubin: An Endogenous Molecule with Antiviral Activity in vitro , 2012, Front. Pharmacol..

[25]  N. Liu High rate of increased level of plasma Angiotensin II and its gender difference in COVID-19: an analysis of 55 hospitalized patients with COVID-19 in a single hospital, WuHan, China , 2020 .

[26]  Dennis Andersson,et al.  A retrospective cohort study , 2018 .

[27]  P. Smaglik,et al.  New perspectives , 2011, Nature.

[28]  A. Cunliffe A SUMMARY OF THE LITERATURE , 1924 .