Acute liver injury following a single dose of celecoxib: A rare case of rapid-onset hepatotoxicity

Celecoxib is a widely prescribed drug for symptomatic pain control. Data regarding its potential to cause deleterious hepatotoxicity is limited. This case report presents a 42-year old man who developed jaundice within 24 hours after intake of one tablet of celecoxib (200 mg) for a tooth extraction. He did not have signs of hepatic encephalopathy, fever or rash. There was no previous drug allergy, herbal medicine or alcohol intake. Laboratory workup showed ALT 699, AST 631 U/L, Total bilirubin 5.17 mg/dL, alkaline phosphatase was elevated at 195 U/L and INR 1.2 with an R factor of 9 indicating a hepatocellular pattern of injury. Serologic tests for Hepatitis A, B & C were non-reactive. Antinuclear Antibody (ANA), anti-smooth muscle antibody (anti-SMA), serum immunoglobulin G, anti-mitochondrial antibody (AMA), and perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA) were all negative. Imaging tests of the liver such as triphasic CT scan and Magnetic Resonance Cholangiopancreatography (MRCP) showed no evidence of biliary obstruction and dilatation. His cholestasis and course of liver disease were prolonged, and ultimately he underwent liver biopsy which showed portal and lobular inflammation and hepatocanalicular cholestasis favoring drug-induced liver injury. Celecoxib was withdrawn, ursodeoxycholic acid 300 mg/tab twice times daily and cetirizine 10 mg/tab OD were started to address his persistent pruritus. His liver biochemical and function tests gradually normalized with symptom resolution after 4 months. Conventional non-steroidal anti-inflammatory drugs like celecoxib may still be associated with significant hepatotoxicity. Swift recognition and cessation of the drug's use are crucial. This case highlights the potential for severe hepatotoxicity even with minimal exposure to celecoxib, underscoring the importance of recognizing this rare but serious adverse reaction. ● Acute liver injury seen within 24 hours of first celecoxib exposure ● Liver biopsy confirmed drug-induced hepatocellular-cholestatic injury ● No alternative causes identified after full autoimmune and viral workup ● Case underscores rare but severe celecoxib-induced hepatotoxicity