SHM Converge Scientific Abstract ePoster Gallery-A K(nac)k for Dili: The Benefits of N-Acetylcysteine in Non-Acetaminophen Related Drug Induced Liver Injury

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This case report describes a potential benefit of N-acetylcysteine (NAC) in non-acetaminophen drug-induced liver injury (DILI). DILI can progress to acute liver failure, and while NAC is well established for acetaminophen toxicity, its role in other forms of DILI is still being investigated.<br /><br />A 42-year-old woman with a history of major depressive disorder developed markedly elevated liver enzymes after starting duloxetine one month earlier. She had no abdominal pain, alcohol use, travel history, sick contacts, or herbal supplement exposure. Initial labs showed AST 355 U/L and ALT 649 U/L, with normal bilirubin and alkaline phosphatase. After duloxetine was stopped, her liver enzymes continued to rise over the following month, peaking at AST 826 U/L and ALT 1,118 U/L. She was then admitted and treated with NAC for 48 hours. After treatment, her liver function tests gradually improved over the next several months, eventually normalizing.<br /><br />The authors discuss how duloxetine can cause delayed hepatocellular injury, typically within 1 to 6 months of initiation, and conclude that the patient’s liver injury was likely medication-related based on the timing and laboratory trends.<br /><br />The report also summarizes possible mechanisms by which NAC may help in non-acetaminophen DILI, including restoring hepatic glutathione, improving liver blood flow via guanylate cyclase, reducing oxidative stress, and lowering inflammatory cytokines such as IL-6, IL-8, and TNF-α.<br /><br />Overall, the case suggests that NAC may be a useful therapeutic option in selected patients with non-acetaminophen DILI because of its antioxidant and hepatoprotective properties.

Asset Subtitle

Bobby Thomas

Meta Tag

Author List Bobby Thomas, Joshua Aron, Nirali Sheth

Category Clinical Vignettes

Concept Drug-Induced Liver Injury

Concept Acute Liver Failure

Concept N-Acetylcysteine

Concept Acetaminophen

Concept Duloxetine

Distinguished Non-Finalist

Presenter Organization Elmhurst Hospital Center

Presenting Author Bobby Thomas

Track Adult

Keywords

N-acetylcysteine

NAC

drug-induced liver injury

DILI

duloxetine

hepatocellular injury

acute liver failure

liver enzymes

glutathione

hepatoprotective

Drug-Induced Liver Injury

Acute Liver Failure

N-Acetylcysteine

Acetaminophen

Duloxetine