Laboratory Investigations and Diagnosis:
The patient had a significantly decreased Hemoglobin concentration (Hb), Hematocrit (HCT), Mean Corpuscular Volume (MCV), Mean Corpuscular Hemoglobin (MCH), and Mean Corpuscular Hemoglobin Concentration (MCHC)(Table 1) . In addition, his Peripheral Smear revealed Hypochromic Microcytic Anisocytosis with Teardrop cells. In addition, his Coagulation Profile was significant for a minutely low Activated Partial Thromboplastin Time. However, the Prothrombin Time and International Normalized Ratio were within the expected parameters.
After five days of admission at the hospital, the Liver Profile showed severely deranged Bilirubin Levels, compared to his pre-admission Liver Profile (Table 2) . Notably, his serum indirect bilirubin was markedly increased throughout his stay at the hospital, consequently showing an exponential rise in serum total bilirubin levels and an increase in serum direct bilirubin to a lesser degree. After administration of phenobarbitone, the patient’s serum total bilirubin declined significantly along with his indirect bilirubin (Table 2) . In addition, there was also a slight decline in his serum GGT and ALP levels post administration of phenobarbitone. In addition to the mildly improved Liver Profile post-administration of phenobarbitone, his scleral icterus also showed marked improvement (Figure 2) . CN-type two was identified based on the patient’s history, clinical examination, laboratory findings, and phenobarbital administration outcomes after ruling out other differential diagnosis such as hemolytic anemia, gilbert’s syndrome and Chronic Liver Disease(CLD).
Further evaluation revealed a markedly low Serum Ferritin, total iron-binding capacity, and Serum Vitamin D3 levels. In addition, the patient blood culture and sensitivity were significant for the growth of Enterobacter, which was sensitive to Polymixin B, Meropenem, and Amikacin. On X-Ray examination, The boy’s bony ossification appeared to give an estimated bone age between 11-12 years. His Upper Gastrointestinal endoscopy revealed mild astral gastritis(Figure 3) . Duodenal Biopsy showed focal partial villous blunting, increased intraepithelial lymphocytes, and milk chronic non-specific inflammation in the lamina propria, subsequently supporting the diagnosis of Celiac Disease.
Treatment Plan:
The patient was prescribed 2mg/kg of Phenobarbitol twice daily and vitamin D3 and was scheduled for a follow-up four weeks later which he did not show up .The patient was discharged from the hospital with adequate counseling for his condition and lifestyle.