Acute Hepatocellular Drug-induced Liver Injury following Cosmetic Liquid Lipo Injection Complicated by Anaphylactic Reaction to N-acetylcysteine

Abstract Drug-induced liver injury (DILI) may occur after exposure to prescription medications, supplements, or non-standardized cosmetic preparations. Cosmetic “liquid lipo” injections are increasingly used for localized fat reduction, but systemic hepatic complications are rarely reported. A 31-year-old woman with no prior liver disease presented with nausea, vomiting, jaundice, and generalized pruritus shortly after receiving a cosmetic “liquid lipo” injection containing deoxycholic acid, phosphatidylcholine, and L-carnitine. Initial laboratory evaluation showed severe hepatocellular liver injury with aspartate aminotransferase 1901 U/L, alanine aminotransferase 2227 U/L, alkaline phosphatase 213 U/L, total bilirubin 6.2 mg/dL, and an R ratio of 6.6. Abdominal imaging showed no biliary obstruction or hepatic mass. Viral, HIV, Epstein–Barr virus, cytomegalovirus, and autoimmune workup were unrevealing. Intravenous N-acetylcysteine (NAC) was initiated for suspected severe DILI, but the patient developed an acute anaphylactic reaction requiring discontinuation of the infusion and treatment with epinephrine, diphenhydramine, and methylprednisolone. She remained hemodynamically stable without encephalopathy or progression to acute liver failure. Liver tests improved with supportive management, and biochemical recovery was documented on outpatient follow-up. Cosmetic liquid lipo injection may be associated with severe hepatocellular DILI. Clinicians should obtain a detailed cosmetic procedure exposure history in unexplained acute liver injury and remain alert to hypersensitivity reactions during intravenous NAC therapy.