title: A Rare Case of Rivaroxaban Causing Delayed Symptomatic Hepatocellular Injury and Hyperbilirubinemia.
abstract: Importance. As Rivaroxaban has increased in popularity, it has been accompanied with a growing body of evidence displaying its ability to cause drug induced liver injury (DILI).Observation. A 74-year-old Caucasian female developed Rivaroxaban DILI two weeks after finishing a 14-day course. The patient was symptomatic and jaundiced with elevated transaminases and hyperbilirubinemia with normal lab values two months priorly. Liver biopsies showed mixed inflammatory infiltrate of lymphocytes, neutrophils and eosinophils, rare necrotic hepatocytes, and canalicular and intrahepatocellular cholestasis, all of which are consistent with DILI.Conclusion and Relevance. We present this case to add to the growing evidence that Rivaroxaban can be associated with severe, symptomatic liver injury and to ensure physicians are aware of these possible side effects of novel anticoagulants with their increasing use.
authors.affiliation: Department of Internal Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA.
authors.forename: Keith
authors.identifier: 0000-0003-1554-5233
authors.initials: K
authors.lastname: Glenn
authors.affiliation: Department of Internal Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: Chen
authors.affiliation: Department of Internal Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Musleh
authors.affiliation: Department of Internal Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA.
authors.forename: Rao
authors.initials: R
authors.lastname: Pallivi
authors.affiliation: Department of Internal Medicine, Wright State University Boonshoft School of Medicine, Dayton, OH, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: Grilliot