Drug-induced acute liver failure
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RUQ pain, deranged LFTs and increasing inflammatory markers.
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The liver has a heterogeneous enhancement pattern; the hepatic veins are not opacified. Portal veins are patent. Periportal edema and fat stranding. Gallbladder wall is mildly thickened.
Horseshoe kidney. Spleen, adrenal glands and pancreas are normal.
Sigmoid diverticular disease without evidence of diverticulitis. Normal appendix. Small bowel is unremarkable. No free gas. Pelvic and right paracolic gutter free fluid. Left fat-containing inguinal hernia.
Moderate sized bilateral pleural effusions.
This patient's viral screens returned negative, but the patient's liver failure worsened requiring multiple ICU admissions. Liver biopsy demonstrated necrosis in keeping with drug toxicity, with either amoxicillin-clavulanic acid or methamphetamine thought to be the likely cause.
- 1. Watkins PB. How to Diagnose and Exclude Drug-Induced Liver Injury. Dig Dis. 2015;33 (4): 472-6. doi:10.1159/000374091 - Pubmed citation
- 2. Björnsson E, Talwalkar J, Treeprasertsuk S et-al. Drug-induced autoimmune hepatitis: clinical characteristics and prognosis. Hepatology. 2010;51 (6): 2040-8. doi:10.1002/hep.23588 - Pubmed citation
- 3. Lewis JH, Ahmed M, Shobassy A et-al. Drug-induced liver disease. Curr. Opin. Gastroenterol. 2006;22 (3): 223-33. doi:10.1097/01.mog.0000218958.40441.fd - Pubmed citation
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11 public playlists include this case
- kejsy #1 (part 15) by Lech Gradziński
- WART ONLINE TEACHING_LIVER by Nathalie Falkner
- GK - Abdo - Liver by GLK
- Acute abdomen part 1 by Peter Poullos
- 2차 시험 by JinHo Kwon
- ER (part 4) by Taimur
- GK - Report writing by GLK
- GI by Taimur
- Fígado pós-quimio by GUILHERME HEIDI YTO DE SOUZA
- Abdomen by Jonas Sender
- abdo- liver gallblader bile ducts by ANA CARLA BENITEZ MENDES