Acute liver injury caused by ultra-short-term use of rosuvastatin calcium

Abstract

A 63-year-old female patient received IV infusions of salvianolate, cattle encephalon glycoside, and pantoprazole and an intramuscular injection of diphenhydramine (only once) in Emergency Department for dizziness, nausea, vomiting, and weakness of lower limbs. Laboratory tests showed no abnormalities in liver function. Craniocerebral CT showed multiple lacunar ischemic demyelination and bilateral internal carotid atherosclerosis. The patient was diagnosed with lacunar cerebral infarction and admitted to hospital. On the night of admission, oral rosuvastatin calcium 10 mg/d and clopidogrel 75 mg/d were given. Eleven hours later, laboratory tests showed aspartate aminotransferase (AST) 254 U/L and alanine aminotransferase (ALT) 157 U/L. Salvianolate and pantoprazole were discontinued and reduced glutathione was given. On day 3 of reduced glutathione treatment, laboratory tests showed AST 587 U/L and ALT 660 U/L. Rosuvastatin calcium-induced liver transaminase elevation was considered. Then rosuvastatin calcium was discontinued and compound glycyrrhizin was given. On day 9 of rosuvastatin calcium withdrawal, laboratory tests showed AST 112 U/L and ALT 201 U/L, and then reduced glutathione was discontinued. On day 15 of rosuvastatin calcium withdrawal, laboratory tests showed AST 42 U/L and ALT 63 U/L, and then compound glycyrrhizin was discontinued. The patient was discharged 4 days later. At 2 weeks of follow-up, no abnormalities in liver function were found in the patient. Key words: Rosuvastatin calcium; Chemical and drug induced liver injury