P1869 - Rescue with Redox: An Underutilized Therapeutic Attempt in Antitubercular Therapy-Induced Liver Injury

Usayd Amin, , Sneh Prakash. Pandey, MD, Mohd Nabil. Beg,
Era's Lucknow Medical College & Hospital, Lucknow, Uttar Pradesh, India

Introduction: Antitubercular Therapy-Induced Liver(AT-DILI) injury lacks validated treatments beyond supportive care. We present the first adult case demonstrating rapid biochemical reversal of severe AT-DILI using intravenous glutathione(GSH) after oral N-acetylcysteine (NAC) failure, averting liver transplantation.

Case Description/

Methods: A 35-year-old male with active pulmonary tuberculosis developed jaundice, pruritus, and coagulopathy with an International Normalized Ratio(INR) of 7.55 and a Model for End-Stage Liver Disease(MELD) score of 34 one month after initiating the first-line antitubercular therapy. Transaminases peaked (Aspartate Aminotransferase 1597 IU/L & Alanine Transaminase 1368 IU/L) with a Roussel Uclaf Causality Assessment Method(RUCAM) score of 9 (highly probable). Conservative management and oral NAC (1.8 g/day) failed to improve liver parameters. We initiated intravenous GSH (1.2 g/day) for 3 days. GSH administration reduced INR to 1.31, and transaminases fell by > 80% within a few days, lowering the MELD score to 13 by day 10 without any adverse events.

Discussion: Unlike NAC, which may have limited efficacy in non-acetaminophen drug-induced liver injury(1), GSH replenishes hepatic redox stores, preserves Adenosine Triphosphate(ATP), and neutralizes reactive metabolites(2,3). This case highlights GSH’s potential as rescue therapy in fulminant AT-DILI, advocating for stage-stratified trials comparing GSH, NAC, and placebo.

1. Orban C et al. Biomedicines. 2024;12(7):1462

2. Saito C et al. Hepatology 2010 Jan;51(1):246-54

3. Aldini G et al. Free Radic Res 2018;52(7):751–62

Disclosures:
Usayd Amin indicated no relevant financial relationships.
Sneh Pandey indicated no relevant financial relationships.
Mohd Beg indicated no relevant financial relationships.

Usayd Amin, , Sneh Prakash. Pandey, MD, Mohd Nabil. Beg, . P1869 - Rescue with Redox: An Underutilized Therapeutic Attempt in Antitubercular Therapy-Induced Liver Injury, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.