20th April 2024

A 68-year-old female presents with general malaise and jaundice. She has a past medical history of rheumatoid arthritis

A 68-year-old female presents with general malaise and jaundice. She has a past medical history of rheumatoid arthritis and, 4 weeks ago, was admitted to hospital with a NSTEMI which was managed with the initiation of dual-antiplatelet therapy and insertion of a coronary stent. At the time of this admission, all liver blood tests were within normal ranges, but on this presentation they demonstrate bilirubin 82, ALT 1300 and ALP 130. All liver screen bloods are negative and liver US shows no biliary obstruction. You suspect drug-induced liver injury and arrange a liver biopsy which demonstrates hepatitis.

Which of the following of the patient’s medications is most likely to be responsible for her acute liver injury?

Select the SINGLE most appropriate option from the list below. Select ONE option only.