Escitalopram oxalate-induced severe liver injury

A 16-year-old female patient received escitalopram oxalate 10 mg once daily for anorexia nervosa.More than one month after receiving the drug,she presented to other hospital with amenorrhea.Liver function tests showed the following results: alanine aminotransferase(ALT) 222 U/L,aspartate aminotransferase(AST) 124 U/L,and albumin 45 g/L.Escitalopram oxalate was discontinued.One week later,the drug was readministered and liver-protective treatment was given at the same time.However,her liver function did not improved and she was hospitalized in Peking Union Medical College Hospital.On admission,her liver function tests showed the following results: ALT 3257 U/L,albumin 37 g/L,TBil 37.7 μmol/L,DBil 21.3 μmol/L.Escitalopram oxalate was stopped immediately and liver-protective drugs such as glutathione,S-adenosylmethionine,compound glycyrrhizin,polyene phosphatidyl choline,sodium glutamate,and potassium glutamate were given.Two months later,her liver function returned to normal,and she was discharged.