29th February 2024

A 19-year-old male of Mediterranean origin presents to the emergency department with a 3 day history of fatigue and shortness of breath, and new-onset jaundice.

A 19-year-old male of Mediterranean origin presents to the emergency department with a 3 day history of fatigue and shortness of breath, and new-onset jaundice.

He is currently being treated for a urinary tract infection.

PM. His maternal grandfather has a haematological disorder, but he is unable to recall the name. NKDA.

On examination

He is visibly jaundiced and mildly short of breath at rest. There is a palpable mass in the LUQ.

Investigations

ALT 27 (5 – 30 IU/L)

ALP 55 (30 – 130 IU/L)

GGT 45 (8 – 60 U/L)

Bilirubin 112 (2 – 17 umol/L)

Albumin 38 (35 – 55 g/L)

Reticulocytes 550 (50 – 100 x 10*9/L)

Select the most likely drug to have caused his abnormal blood results