Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Oct 27, 2019; 11(10): 719-724
Published online Oct 27, 2019. doi: 10.4254/wjh.v11.i10.719
Escitalopram-induced liver injury: A case report and review of literature
Qin Xiang Ng, Christl Suet Kwan Yong, Wayren Loke, Wee Song Yeo, Alex Yu Sen Soh
Qin Xiang Ng, Christl Suet Kwan Yong, Institute of Mental Health, Buangkok Green Medical Park, Singapore 539747, Singapore
Qin Xiang Ng, Christl Suet Kwan Yong, Wayren Loke, MOH Holdings Pte Ltd, Singapore 099253, Singapore
Wee Song Yeo, Alex Yu Sen Soh, National University Hospital, National University Health System, Singapore 119074, Singapore
Wee Song Yeo, Alex Yu Sen Soh, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
Author contributions: Ng QX conceived, designed and carried out the study, and the relevant data analysis and interpretation, while Soh AYS supervised the study; Yong CSK, Loke WR, Soh AYS and Yeo WS carried out the study, and the relevant data analysis and interpretation; All authors contributed to the writing and proofreading of the final manuscript; The final manuscript was discussed and approved by all authors.
Informed consent statement: Written consent was obtained from the patient.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Qin Xiang Ng, MBBS, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore 539747, Singapore. ng.qin.xiang@u.nus.edu
Telephone: +65-66386979
Received: July 21, 2019
Peer-review started: July 24, 2019
First decision: August 7, 2019
Revised: August 20, 2019
Accepted: October 2, 2019
Article in press: October 2, 2019
Published online: October 27, 2019
Processing time: 94 Days and 19.7 Hours
Abstract
BACKGROUND

Depression is a growing public health problem that affects over 350 million people globally and accounts for approximately 7.5% of healthy years lost due to disability. Escitalopram, one of the first-line medications for the treatment of depression, is a selective serotonin reuptake inhibitor and one of the most commonly prescribed antidepressant medications worldwide. Although thought to be generally safe and with minimal drug-drug interactions, we herein present an unusual case of cholestatic liver injury, likely secondary to escitalopram initiation.

CASE SUMMARY

A 56-year-old Chinese lady presented with fever and cholestatic liver injury two weeks after initiation of escitalopram for the treatment of psychotic depression. Physical examination was unremarkable. Further investigations, including a computed tomography scan of the abdomen and pelvis and tests for hepatitis A, B and C and for autoimmune liver disease were unyielding. Hence, a diagnosis of escitalopram-induced liver injury was made. Upon stopping escitalopram, repeat liver function tests showed downtrending liver enzymes with eventual normalization of serum aspartate aminotransferase and alanine aminotransferase one-week post-discharge.

CONCLUSION

Clinicians should be aware of the possibility of escitalopram-induced liver injury when initiating depressed patients on antidepressant treatment. This requires extra vigilance as most patients may remain asymptomatic. Measurement of liver function tests could be considered after initiation of antidepressant treatment, especially in patients with pre-existing liver disease.

Keywords: Depression; Antidepressant; Escitalopram; Liver injury; Drug-induced; Drug-induced liver injury

Core tip: We herein report a probable case of escitalopram-induced liver injury. A 56-year-old Chinese lady presented with fever and cholestatic liver injury two weeks after initiation of escitalopram for the treatment of psychotic depression. Physical examination and investigations for stones, viral hepatitis and autoimmune liver disease were unyielding. Upon stopping escitalopram, repeat liver function tests showed downtrending liver enzymes with eventual normalization of serum aminotransferase levels. Clinicians should be aware of the possibility of drug-induced liver injury associated with escitalopram use, when initiating depressed patients on antidepressant treatment. This requires extra vigilance as most patients may remain asymptomatic.