Acute liver injury induced by oral iron preparation

A 65-year-old female patient with iron-deficiency anemia received conventional ferrous succinate 0.1 g thrice daily by mouth. On the second day of treatment, the patient developed nausea, acid reflux, and diarrhea. On the third day and the 4th day, her alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were 155 U/L and 438 U/L, 470 U/L and 867 U/L, respectively. Acute drug-induced liver injury (DILI) was considered. Ferrous succinate was withdrawn and an IV infusion of polyene phosphatidylcholine 465 mg once daily was given. Her gastrointestinal symptoms relieved and ALT and AST levels returned to 37 U/L and 25 U/L after a week of treatment. Then the patient was given IV infusion of iron sucrose injection 100 mg every other day. Ten days later, hemoglobin level increased to 97 g/L and no gastrointestinal symptoms and liver injury appeared. Then she was discharged. Six months later, the patient was admitted to hospital again because of IDA. Ferrous sulfate and vitamin one pill once daily was given. On the 4th day, the levels of ALT and AST were 98 U/L and 209 U/L, respectively. Ferrous sulfate and vitamin was stopped and liver-protective treatment was given. Three days later, her ALT and AST levels were 36 U/L and 34 U/L. At 3 years of follow-up, it was found that the patient was admitted to hospital many times, IV infusion of iron sucrose injection was given each time, and no liver injury recurred. Key words: Ferrous Compounds; Drug-induced liver injury