{
    "abstract": "Acute liver failure (ALF) is a rare, life-threatening condition that may be secondary to drug-induced liver injury (DILI) and certain viral infections. We present the case of a 73-year-old male with a history of fibrotic hypersensitivity pneumonitis with a progressive phenotype, type 2 diabetes mellitus, hypertension, and hyperlipidemia, who was admitted with ALF potentially secondary to DILI. Prior to admission, he was receiving therapy that may be related to idiosyncratic DILI (I-DILI) and ALF, namely nintedanib, which appears to have a most probable relation to I-DILI in this case, considering it was the most recently started drug. Herpes simplex virus (HSV) type 1\u00a0was also identified\u00a0and probably potentiated I-DILI development and ALF. Considering the patient's history and previous medical status, he was not considered eligible for liver transplantation in the setting of a multidisciplinary discussion.\u00a0Despite therapy with N-acetylcysteine and acyclovir, there was progressive clinical deterioration with worsening of encephalopathy, and the patient\u00a0died. This case represents a rare and complex situation of ALF following I-DILI potentiated by HSV type 1 infection, reflecting its high mortality risk in patients not undergoing liver transplantation.",
    "authors": [
        {
            "affiliation": "Internal Medicine, Unidade Local de Sa\u00fade de S\u00e3o Jos\u00e9, Lisbon, PRT.",
            "firstname": "Ana Raquel",
            "initials": "AR",
            "lastname": "Soares"
        },
        {
            "affiliation": "Internal Medicine, Unidade Local de Sa\u00fade de S\u00e3o Jos\u00e9, Lisbon, PRT.",
            "firstname": "Pedro",
            "initials": "P",
            "lastname": "Fi\u00faza"
        },
        {
            "affiliation": "Pulmonology, Unidade Local de Sa\u00fade de S\u00e3o Jos\u00e9, Lisbon, PRT.",
            "firstname": "Jo\u00e3o",
            "initials": "J",
            "lastname": "Rodrigues"
        },
        {
            "affiliation": "Internal Medicine, Unidade Local de Sa\u00fade de S\u00e3o Jos\u00e9, Lisbon, PRT.",
            "firstname": "Marta",
            "initials": "M",
            "lastname": "Guisado Orantos"
        },
        {
            "affiliation": "Internal Medicine, Unidade Local de Sa\u00fade de S\u00e3o Jos\u00e9, Lisbon, PRT.",
            "firstname": "Paula",
            "initials": "P",
            "lastname": "Nascimento"
        }
    ],
    "conclusions": null,
    "copyrights": "Copyright \u00a9 2024, Soares et al.",
    "doi": "10.7759/cureus.74955",
    "journal": "Cureus",
    "keywords": [
        "acute liver failure",
        "drug-induced liver injury",
        "hepatic encephalopathy",
        "herpes simplex virus",
        "nintedanib"
    ],
    "methods": null,
    "publication_date": "2025-01-02",
    "pubmed_id": "39744247\n37377263\n28417882\n27956449\n36968618\n35631471\n38384288\n31643176\n36134121\n31643176\n31643176\n31643176\n31643176\n31643176\n31643176\n31643176\n31183293\n18825709",
    "results": null,
    "title": "A Complex Case of Acute Liver Failure Following Idiosyncratic Drug-Induced Liver Injury, Potentiated by Herpes Simplex Virus Infection.",
    "xml": "<Element 'PubmedArticle' at 0x788503fba840>"
}