A 20-Year-Old Man Is Evaluated in the Clinic Due to Intermittent

A 20-year-old man is evaluated in the clinic due to intermittent episodes of self-resolving jaundice.  His symptoms are not provoked by any particular circumstances or events.  The patient otherwise feels healthy and has no other symptoms.  He does not use tobacco, alcohol, or illicit drugs.  Complete blood count is within normal limits.  Liver function studies are as follows: Liver biopsy shows abundant pigment inclusions in the lysosomes of the otherwise normal hepatocytes.  Electron spin resonance spectroscopy reveals that the pigment is composed of polymers of epinephrine metabolites.  Which of the following is the most likely cause of this patient's jaundice?

A) Defective hepatocellular excretion of bilirubin glucuronides
B) Impaired conjugation of bilirubin
C) Increased production of catecholamines
D) Ineffective intramedullary erythropoiesis
E) Low serum ceruloplasmin

Correct Answer:

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