SHM Converge Scientific Abstract ePoster Gallery-Asenapine-Related Liver Failure: Exploring an Uncommon Clinical Presentation

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This case report describes a rare and severe episode of liver injury linked to transdermal asenapine, an atypical antipsychotic. A 39-year-old woman with a history of gastric bypass and hypertension presented with nausea, vomiting, and sudden right upper quadrant abdominal pain. She had no fever, altered mental status, or signs of infection, and her vital signs were stable.<br /><br />Initial lab testing showed extreme hepatocellular injury with AST 4634 U/L, ALT 5922 U/L, and an elevated INR of 2.7, while bilirubin, ammonia, ALP, and lactate were not markedly abnormal. Viral hepatitis testing, serologies, toxicology studies for aspirin and acetaminophen, and abdominal CT imaging were negative, helping rule out common causes of acute liver injury. A liver biopsy showed widespread ballooning degeneration and necrosis, mainly in zone 3, consistent with acute severe liver damage.<br /><br />The key suspected trigger was recent initiation of a transdermal asenapine patch about two weeks before symptom onset. The medication was stopped on admission. Because of concern for impending acute liver failure, transplant evaluation was considered, but the patient improved clinically and biochemically, so transfer was not needed. By discharge, liver enzymes had decreased significantly, and further improvement was seen at two-week follow-up.<br /><br />The authors note that mild liver enzyme elevations can occur with atypical antipsychotics, but severe hepatotoxicity is uncommon. This appears to be the first reported case of severe liver failure associated with transdermal asenapine. The report emphasizes the importance of monitoring liver enzymes when clinically indicated, especially soon after starting asenapine or other atypical antipsychotics.

Asset Subtitle

Musaab Alfaki

Meta Tag

Author List Akram Babkir, Mohammed Salih, Moutaz Taha, Musaab Alfaki

Category Clinical Vignettes

Concept Asenapine

Concept Drug-Induced Liver Injury

Concept Acute Liver Failure

Concept Hepatotoxicity

Concept AST

Distinguished Non-Finalist

Presenter Organization University of Missouri

Presenting Author Musaab Alfaki

Track Adult

Keywords

transdermal asenapine

hepatotoxicity

acute liver injury

atypical antipsychotic

liver failure

elevated AST

elevated ALT

liver biopsy

zone 3 necrosis

drug-induced liver injury

Asenapine

Drug-Induced Liver Injury

Acute Liver Failure

Hepatotoxicity

AST