Research Day
A 34-YEAR-OLD RECOVERING ALCOHOLIC WITH ACUTE LIVER FAILURE
Document Type
Abstract
Date
2021
Abstract
Introduction: Acute liver failure is a rare condition characterized by rapidly deteriorating liver function, altered mentation, and coagulopathy in individuals without pre-existing liver disease. The most common causes include drug-induced liver injury, viral hepatitis, autoimmune liver disease and shock. We present a case of a 34-year-old woman who developed acute liver failure during treatment for alcohol addiction with disulfiram.
Case History: The patient presented to the emergency department with four days of fatigue, nausea, vomiting, and upper abdominal pain. She had recently undergone inpatient treatment for alcohol withdrawal and was started on disulfiram at discharge. Two weeks into sobriety, she presented with the above symptoms and appeared mildly icteric. She was found to have AST 11,806, ALT 6,625, as well as, hyperbilirubinemia, and elevated INR. Abdominal ultrasound with doppler demonstrated normal hepatobiliary architecture with patent hepatic vasculature. Disulfiram was held and patient was started on supportive treatment. Workup for autoimmune, acute viral illness, Wilsons disease, and hemochromatosis was negative. The patient had steady decrease in transaminases and improvement in coagulopathy. Disulfiram was discontinued. The patient's liver function gradually improved, returning to normal within six weeks.
Discussion: Few etiologies can raise liver enzymes into 10,000s. This pattern of liver injury and rapid improvement with discontinuation of disulfiram and supportive care suggests drug in duced liver injury. Only a handful of cases of disulfiram toxicity have been reported and we suggest this as the likely culprit in this case.