P1862 - Oral N-Acetylcysteine in Hepatitis C-Induced Acute Liver Injury: A Case Report

Mohammed I. Khan, DO, DPT¹, Shuchita Jhaveri, MD, MPH², Jonathan Nguyen, MD², Renu Thomas, MD², Jeffrey Lesser, DO², Kevin Garnepudi, DO², Ahmed Ouni, MD², Galvin S. Dhaliwal, MD³, Kaylah Perez, ⁴, Julian Nguyen, DO²
1HCA Healthcare Kingwood Hospital/University of Houston, Missouri City, TX; 2HCA Healthcare Kingwood Hospital/University of Houston, Kingwood, TX; 3HCA Healthcare Kingwood Hospital/University of Houston, Houston, TX; 4University of Houston Tilman J. Fertitta Family College of Medicine, Kingwood, TX

Introduction: While N-acetylcysteine (NAC) is well-established for acetaminophen-induced liver failure, its role in non-acetaminophen acute liver injury (e.g., viral hepatitis, drug-induced) remains debated. Prior studies (e.g., Nabi et al.) demonstrate improved survival with intravenous (IV) NAC in non-acetaminophen liver failure, but data on oral NAC in hepatitis C (HCV) are limited. This case highlights a patient with chronic liver diseases of HCV and non-alcoholic fatty liver disease (NAFLD) who was started on oral NAC in the setting of non-acetaminophen liver failure.

Case Description/

Methods: A 54-year-old male with a past medical history of HCV (previously treated/sustained virological response), NAFLD, and recent cocaine/methamphetamine use presented with cough and markedly elevated transaminases (AST 778, ALT 1069). Workup ruled out acetaminophen toxicity, malignancy, and acute viral hepatitis. On hospital day 5, oral NAC (600 mg BID) was initiated for suspected drug-induced liver injury superimposed on chronic liver diseases of HCV and NAFLD. Liver enzymes downtrended by discharge (AST 505, ALT 1351).

Discussion: This case highlights oral NAC as a potential adjunct in HCV-related acute liver injury, despite its primary use for acetaminophen toxicity. The patient’s improvement aligns with proposed NAC mechanisms: glutathione replenishment and mitigation of oxidative stress. Notably, prior studies focused on IV NAC in heterogeneous liver failure etiologies; our report adds to limited evidence supporting oral NAC in HCV. Oral NAC may benefit select patients with HCV and acute liver injury, particularly when IV formulations are unavailable or contraindicated. Further studies are needed to define optimal dosing, timing, and patient selection.

Disclosures:
Mohammed Khan indicated no relevant financial relationships.
Shuchita Jhaveri indicated no relevant financial relationships.
Jonathan Nguyen indicated no relevant financial relationships.
Renu Thomas indicated no relevant financial relationships.
Jeffrey Lesser indicated no relevant financial relationships.
Kevin Garnepudi indicated no relevant financial relationships.
Ahmed Ouni indicated no relevant financial relationships.
Galvin Dhaliwal indicated no relevant financial relationships.
Kaylah Perez indicated no relevant financial relationships.
Julian Nguyen indicated no relevant financial relationships.

Mohammed I. Khan, DO, DPT¹, Shuchita Jhaveri, MD, MPH², Jonathan Nguyen, MD², Renu Thomas, MD², Jeffrey Lesser, DO², Kevin Garnepudi, DO², Ahmed Ouni, MD², Galvin S. Dhaliwal, MD³, Kaylah Perez, ⁴, Julian Nguyen, DO². P1862 - Oral N-Acetylcysteine in Hepatitis C-Induced Acute Liver Injury: A Case Report, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.