Drug‐induced liver injury as assessed by the updated Roussel Uclaf Causality Assessment Method following mild COVID‐19 in a patient under anastrozole therapy—A case report

Abstract

BackgroundAnastrozole is a selective aromatase inhibitor used for the treatment of postmenopausal hormone‐sensitive breast cancer. The major side effects include osteoporosis, hypercholesterolemia, and musculoskeletal events, such as arthralgia and myalgia. Other adverse events are rare, including symptoms of acne, masculinization, and drug‐induced liver injury, with the latter reported in a few cases only.CaseHere, we report on a patient under anastrozole therapy who developed drug‐induced liver injury as assessed by the updated Roussel Uclaf Causality Assessment Method 5 weeks after a mild SARS‐CoV‐2 infection, which is, to the best of our knowledge, the first report of its kind involving anastrozole. Discontinuation of anastrozole resulted in a marked improvement of the alanine aminotransaminase, and aspartate aminotransaminase as well as normalized lactate dehydrogenase serum levels already seen after 26 days. Surprisingly, however, the cholestatic serum markers gamma‐glutamyl transpeptidase and alkaline phosphatase showed a further rise, and took another 4 weeks to drop significantly.ConclusionThe presentation of this case is meant to alert physicians to a potential drug‐induced liver injury following mild SARS‐CoV‐2 infection in patients under anastrozole medication.