title: Diphenhydramine as a Cause of Drug-Induced Liver Injury.
abstract: Drug-induced liver injury (DILI) is the most common cause of acute liver failure in the Unites States and accounts for 10% of acute hepatitis cases. We report the only known case of diphenhydramine-induced acute liver injury in the absence of concomitant medications. A 28-year-old man with history of 13/14-chromosomal translocation presented with fevers, vomiting, and jaundice. Aspartate-aminotransferase and alanine-aminotransferase levels peaked above 20,000 IU/L and 5,000 IU/L, respectively. He developed coagulopathy but without altered mental status. Patient reported taking up to 400 mg diphenhydramine nightly, without concomitant acetaminophen, for insomnia. He denied taking other medications, supplements, antibiotics, and herbals. A thorough workup of liver injury ruled out viral hepatitis (including A, B, C, and E), autoimmune, toxic, ischemic, and metabolic etiologies including Wilson's disease. A liver biopsy was consistent with DILI without evidence of iron or copper deposition. Diphenhydramine was determined to be the likely culprit. This is the first reported case of diphenhydramine-induced liver injury without concomitant use of acetaminophen.
authors.affiliation: Department of Gastroenterology and Hepatology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Yunseok
authors.identifier: 0000-0002-1023-8878
authors.initials: Y
authors.lastname: Namn
authors.affiliation: Department of Gastroenterology and Hepatology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Yecheskel
authors.identifier: 0000-0002-0680-3627
authors.initials: Y
authors.lastname: Schneider
authors.affiliation: Department of Pathology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Isabelle H
authors.initials: IH
authors.lastname: Cui
authors.affiliation: Department of Gastroenterology and Hepatology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Arun
authors.identifier: 0000-0002-8562-3375
authors.initials: A
authors.lastname: Jesudian