Acute Liver Injury in a Patient Treated With Rosuvastatin: A Rare Adverse Effect

Abstract

Drug-induced liver injury (DILI) is among the challenging liver conditions encountered by clinicians today. It has a low incidence in the general population with an approximated annual incidence of 10 - 15 cases per 10,000 - 100,000 persons who have taken prescription medications. Nevertheless, DILI remains the most frequent cause of acute liver injury in the United States. Rosuvastatin is a commonly prescribed medication that, similar to other statins, is associated with serum aminotransferase elevations that are mild, asymptomatic and usually self-limited. Here, we report a case of a man who developed acute liver injury after taking rosuvastatin for hypercholesterolemia treatment. Moreover, DILI with autoimmune features represents a key subgroup of hepatotoxicity attributable to medication exposure. Similar to idiopathic autoimmune hepatitis, circulating autoantibodies and a hypergammaglobulinemia are often present in the serum of such individuals. However, such findings are not invariable. In the case reported here, these laboratory features were absent, but a liver biopsy demonstrated interface hepatitis with a prominent plasma cell infiltrate, histologic components consistent with an immune-mediated drug reaction. After withdrawal of the offending medication did not result in complete resolution, corticosteroid therapy was administered with a subsequent clinical response, confirming the diagnosis.

Statin-induced Liver Injury Patterns: A Clinical Review

“…Using the Scopus, PubMed, and Google Scholar databases, we identified 531 manuscripts using the key words "statin" and "liver injury". Of the 15 manuscripts evaluated, there were nine case reports, [10][11][12][13][14][15][16][17][18] two of which discussed two patients. 11,17 The case reports are summarized in Table 1.…”

“…The other seven patients were followed by serial aminotransferase and imaging studies. [10][11][12][13][14][15][16][17][18] Eight of the patients had reported normal baseline aminotransferases prior to initiation of statin therapy, and nine had resolution of aminotransferase elevations following discontinuation of statin therapy, although three had also received steroid maintenance therapy. [10][11][12][13][14][15][16][17][18] None of the case reports took into consideration the possible presence of nonalcoholic fatty liver disease or elevated body mass index.…”

“…Changes in aminotransferases suggestive of hepatocellular pattern liver injury have been observed as early as a few hours after initial statin exposure to as late as 8 months after initiation. [10][11][12][13][14][15][16][17][18] While statin-induced hepatocellular liver injury is predominantly selflimiting and generally resolves within 6 months of offending agent cessation, some cases had autoimmune features and were treated with a brief steroid course to accelerate resolution. 10,11 A few reports described attempts at statin rechallenge, although with alternate formulations that did not induce liver injury.…”

Drug-induced liver injury after switching from tamoxifen to anastrozole in a patient with a history of breast cancer being treated for hypertension and diabetes

“…42,43 Acute DILI related to rosuvastatin monotherapy is rare. 43,44 In our patient, re-introduction of rosuvastatin after resolution of the DILI did not result in an increase in aminotransferases or bilirubin, thus an interaction between telmisartan and rosuvastatin was probably not associated with the hepatotoxicity and cholestasis seen after starting anastrozole. Newer angiotensin II receptor blockers such as olmesartan, telmisartan, and eprosartan have not been linked to cases of hepatotoxicity.…”

Statin therapy in chronic viral hepatitis: a systematic review and meta-analysis of nine studies with 195,602 participants

“…Some drug-induced liver injuries (DILI) with autoimmune features have been related to statin use [11]. In most cases, it is characterised by a transient elevation less than three times the normal upper limit of liver transaminases which subsides spontaneously with treatment discontinuation [12]; in some other cases, it is characterised by an acute form of hepatitis with a significant rise in transaminases leading to hepatic failure [13,14]. The risk of statin-related liver toxicity seems to be higher in the elderly, especially when it is accompanied by alcohol consumption and hepatitis [15].…”