SHM Converge Scientific Abstract ePoster Gallery-Statin-Induced Autoantibody Associated Drug Induced Liver Injury Following Successful Pci

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This case describes a 79-year-old woman with hypertension and hyperlipidemia who presented after syncope and was found to have intermittent polymorphic ventricular tachycardia. She was transferred for cardiac catheterization, which revealed an 80% proximal left anterior descending artery lesion, treated with a drug-eluting stent. Due to markedly elevated lipids, she was started on high-dose atorvastatin 80 mg daily.<br /><br />Soon after discharge, she developed rising liver enzymes, with a cholestatic/transaminitis pattern and normal bilirubin and creatine kinase. When atorvastatin was stopped, her AST, ALT, and alkaline phosphatase improved significantly, and initial autoimmune markers were negative. Drug-induced liver injury (DILI) was suspected, and she was switched to a PCSK9 inhibitor without complications.<br /><br />One year later, during a hospitalization for gastrointestinal bleeding, atorvastatin was restarted because PCSK9 therapy was unavailable inpatient. After discharge, liver enzymes again became elevated. This time, ANA was positive at 1:160 with a speckled pattern and anti-smooth muscle antibody (ASMA) was also positive at 1:160. After atorvastatin was held again, liver enzymes normalized and ASMA decreased to 1:40, supporting statin-induced autoimmune antibody-associated DILI rather than true autoimmune hepatitis.<br /><br />The report emphasizes that DILI from statins is rare but important, especially with high-dose atorvastatin after acute coronary syndrome. Because DILI and autoimmune hepatitis can appear similar, careful medication review, follow-up labs, and use of resources such as LiverTox are important. The key lesson is that recognizing the statin as the offending agent prevented ongoing liver injury and potential long-term damage.

Asset Subtitle

Suhwoo Bae

Meta Tag

Author List Bernardo Acevedo-Mendez MD, Michael Vaysblat, Suhwoo Bae, Yuting Ye

Category Clinical Vignettes

Concept Drug-Induced Liver Injury

Concept Statin

Concept Offending Agent Withdrawal

Concept Transaminitis

Concept Autoimmune Hepatitis

Distinguished Non-Finalist

Presenter Organization Northwell/ NSLIJ

Presenting Author Suhwoo Bae

Track Adult

Keywords

atorvastatin

drug-induced liver injury

statin hepatotoxicity

autoimmune hepatitis

anti-smooth muscle antibody

ANA positive

cholestatic transaminitis

PCSK9 inhibitor

acute coronary syndrome

liver enzymes

Drug-Induced Liver Injury

Statin

Offending Agent Withdrawal

Transaminitis

Autoimmune Hepatitis