S5391 Hidden Hepatotoxicity: Amoxicillin-Clavulanate-Induced Liver Injury in a Diabetic Patient

Introduction: Drug-induced liver injury (DILI) is an idiosyncratic adverse reaction and a leading cause of acute non-infectious liver damage. It presents as liver biochemical abnormalities triggered by medications, herbs, or supplements. Incidence is 10–15 per 100,000 individuals; antibiotics account for 50% of cases. Amoxicillin-clavulanate has an estimated incidence of 1 in 7,000, especially in males >55. We report a case of jaundice after amoxicillin-clavulanate exposure in a 76-year-old man. Case Description/Methods: A 76-year-old man with controlled type 2 diabetes developed jaundice after a 10-day course of amoxicillin-clavulanate for pharyngeal erythema due to foreign body trauma. Labs: total bilirubin 19.2 mg/dL (direct 16.9), alkaline phosphatase 171, gamma-glutamyl transferase 183, aspartate aminotransferase 76, alanine aminotransferase 140, international normalized ratio 1.58. Viral and autoimmune causes were excluded. R-factor: 4.9 (mixed injury); RUCAM: 6 (probable DILI). Imaging showed hepatomegaly and gallbladder wall thickening. Liver biopsy: cholestatic hepatitis with periportal inflammation. Withdrawal of the drug led to clinical and biochemical resolution. Discussion: DILI, often due to antibiotics, is a major cause of acute liver injury. Amoxicillin-clavulanate frequently causes cholestatic or mixed patterns, with bilirubin and alkaline phosphatase elevation. Risk factors: male sex, age >55, prior exposure, HLA-DRB1*1501. Clavulanate likely triggers immune-mediated damage. Management is supportive and based on drug cessation. This case highlights the importance of early recognition of DILI and reinforces pharmacovigilance amid widespread antibiotic use.