Hydroxychloroquine-Induced Hepatotoxicity in Systemic Lupus Erythematous: A Case Report and Literature Review

Hydroxychloroquine (HCQ) is a medication that is commonly used as an antimalarial or disease-modifying anti-rheumatic drug (DMARD). Adverse side effects typically include retinal damage, cardiomyopathy, and neuromyopathy. However, there has been relatively little documentation on the effects of HCQ toxicity on the liver. We describe a case of HCQ-induced hepatic failure in a 31-year-old female patient on HCQ for systemic lupus erythematous who presented with three days of fever, diarrhea, and non-bilious, non-bloody vomiting. Labs showed massively elevated liver function tests (LFTs) and negative viral serology. The abdominal ultrasound and magnetic resonance cholangiopancreatography were unremarkable. A liver biopsy showed portal tracts with mild to moderate expansion by mixed inflammatory infiltrates, including scattered eosinophils and rare plasma cells with occasional mild interface activity focally close to bridging inflammation. These findings are consistent with drug-induced liver injury (DILI). HCQ was subsequently held, and the patient was admitted to the ICU for conservative management. Repeat LFTs showed down-trending over the course of the patient's four days of admission after discontinuation of HCQ and returned to baseline within a two-month timeframe.