Acute Hepatocellular Drug-induced Liver Injury following Cosmetic Liquid Lipo Injection Complicated by Anaphylactic Reaction to N-acetylcysteine.
Sirpi Vivekanandam Sachithanandam, Nishanth Somashekar, Anand Dev
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Case in brief
A 31-year-old woman without prior liver disease developed nausea, vomiting, jaundice, and generalized pruritus shortly after a cosmetic “liquid lipo” injection containing deoxycholic acid, phosphatidylcholine, and L-carnitine. Testing showed severe hepatocellular injury (AST 1901 U/L, ALT 2227 U/L; R ratio 6.6); imaging and viral and autoimmune investigations did not identify an alternative cause. During intravenous N-acetylcysteine for suspected drug-induced liver injury, she developed anaphylaxis, prompting discontinuation and treatment with epinephrine, diphenhydramine, and methylprednisolone. She remained stable without encephalopathy or acute liver failure, and liver tests improved with supportive care, with biochemical recovery documented at outpatient follow-up.
What made this case unusual
The case combined severe hepatocellular injury after a cosmetic injection with an acute anaphylactic reaction to intravenous N-acetylcysteine, complicating management.
Diagnostic / clinical pearl
In unexplained acute hepatocellular injury, ask specifically about cosmetic injections and other non-standardized preparations; monitor for hypersensitivity during intravenous N-acetylcysteine.