A 56-year-old female was admitted to our hospital because of epigastralgia, vomiting, hyperbilirubinemia, and abnormalities in the hepatic function tests. After the discontinuation of an over-the-counter drug, her symptoms and the abnormalities in the blood tests were improved. Thus she was diagnosed as drug-induced liver injury by the over-the-counter drug. The second episode of drug-induced liver injury occurred when she took Fluvastatin Sodium for her hyperlipemia. The liver injury was improved by the discontinuation of the drug
however, only serum indirect bilirubin level remained abnormal. She was suspected to have constitutional jaundice, and diagnosed as Gilbert's syndrome by the analysis of gene polymorphism for UDP-glucuronyl transferase (UGT1A1). The polymorphism of UGT1A1 affects the efficiency of the lipophilic drug metabolism, and the activity of UGT1A1 is known to be low in the patients with Gilbert's syndrome Therefore the present case suggests that the recurrent drug-induced liver injury might be related to the low UGT1A1 activity due to Gilbert's syndrome. We here report the case with Gilbert's syndrome complicated with the recurrent drug-induced liver injuries. © 2009 The Japan Society of Hepatology.