SHM Converge Scientific Abstract ePoster Gallery-A Rare Case of Lisinopril Induced Liver Injury in a Patient With Concurrent Semaglutide Use

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This report describes a rare case of lisinopril-induced drug-induced liver injury (DILI) in a 58-year-old woman with hypertension and GERD who presented with two weeks of jaundice. She had marked liver enzyme elevation and hyperbilirubinemia (AST 1527 U/L, ALT 1186 U/L, total bilirubin 13.5 mg/dL). Her workup was negative for common causes of acute liver injury, including alcohol, acetaminophen, viral hepatitis, autoimmune disease, malignancy markers, and structural liver disease on imaging.<br /><br />Medication review showed she had been taking lisinopril for eight months, omeprazole for eight months, and subcutaneous semaglutide for three months. Liver biopsy demonstrated severe acute hepatitis with centrilobular necroinflammation, parenchymal collapse, and bridging necrosis, findings most consistent with DILI. The liver injury pattern was hepatocellular, supported by a high R ratio of 17.64. The RUCAM score was 9, making lisinopril-related hepatotoxicity “highly probable.”<br /><br />The patient was treated with prednisone and instructed to stop lisinopril. Her liver tests later normalized on outpatient follow-up, supporting the diagnosis of lisinopril-induced DILI.<br /><br />The authors note that lisinopril-associated liver injury is rare, but reported cases include both hepatocellular and cholestatic patterns. The exact mechanism is unclear, though ACE-inhibitor effects on bradykinin and prostaglandins may contribute to impaired bile flow and liver injury. They also raise the possibility that concurrent semaglutide use may have potentiated the hepatotoxic effect, since both drugs may inhibit NF-kB signaling and promote inflammation, although this interaction has not been established and semaglutide alone has not been linked to reported liver injury.<br /><br />This case adds to the limited literature on lisinopril hepatotoxicity and highlights the need for awareness of rare but serious adverse drug reactions, especially in patients taking multiple medications.

Asset Subtitle

Elona Poltiyelova

Meta Tag

Author List Bernard Partiula, Dovid Kotkes, Elona Poltiyelova, Richard Oletsky

Category Clinical Vignettes

Concept ACE Inhibitor

Concept Drug-Induced Liver Injury

Concept R Factor

Concept RUCAM Score

Concept Medication Review

Distinguished Non-Finalist

Presenter Organization Westchester Medical Center

Presenting Author Elona Poltiyelova

Track Adult

Keywords

lisinopril

drug-induced liver injury

DILI

hepatocellular injury

jaundice

acute hepatitis

RUCAM score

liver biopsy

hepatotoxicity

semaglutide

ACE Inhibitor

Drug-Induced Liver Injury

R Factor

RUCAM Score

Medication Review