Drug-induced acute liver failure

Case contributed by Henry Knipe
Diagnosis almost certain


RUQ pain, deranged LFTs and increasing inflammatory markers.

Patient Data

Age: 30
Gender: Male

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.

Case Discussion

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. 

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.