Successful Treatment of Drug-induced Acute Liver Failure with Therapeutic Plasma Exchange: A Case Report

Glasgow Coma Scale (GCS) was 13/15, and vital signs were stable.Initial blood investigations showed direct hyperbilirubinemia, acute kidney injury (AKI) (Table 1).The patient was admitted to the medical intensive care unit (ICU).The fever workup included testing for viral markers of various hepatitis types (A through E), cytomegalovirus (CMV), Epstein-Barr virus (EBV), and herpes simplex virus (HSV), all of which returned negative results.There were no rashes or eosinophilia, thus ruling out hypersensitivity reactions.Abdominal ultrasound IntroductIonDrug-induced liver injury (DILI) is a life-threatening condition that can lead to liver failure and other problems.The prevalence of DILI in the general public is approximately 1 in 10,000 to 1 in 1,00,000 individuals. 1However, clinicians should always consider the possibility of DILI in unexplained acute and chronic liver failure cases.DILI is typically categorized into two forms: intrinsic (direct) and idiosyncratic.Intrinsic DILI refers to liver damage due to drugs in a predictable and dose-dependent manner, typically with a rapid onset.In contrast, idiosyncratic DILI occurs independently of the drug's dosage but requires a minimum threshold dose, with an onset that can vary from days to weeks. 2 case descrIptIonA male patient, aged 64, with a medical history of hypertension, type 2 diabetes mellitus, dyslipidemia, and benign prostatic hypertrophy, maintained on regular medication for approximately 10 years, presented with a history of fever and loose stools for 2 days, along with altered sensorium for 1 day.He denied any history of headache, vomiting, or seizures, head trauma, weakness of limbs, facial deviation, or drug overdose.There was no history of intermittent jaundice, fever, or signs of infection in the past.On examination, the patient was drowsy, dehydrated, and had yellowish discoloration of the sclera.Multiple scratch marks were present all over the body.There were no signs suggestive of chronic liver disease, meningeal irritation, or focal neurological deficits.