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A woman in her 40's· developed drug induced liver injury (DILI), vanishing bile duct syndrome (VBDS), cholestasis and hyperlipidaemia during treatment with ibuprofen for menalgia.
The woman presented with acute onset of jaundice which had worsened over the period of 30 days, following intermittent treatment with ibuprofen for menalgia. She showed profound fatigue and dark urine. Twelve months before the onset of jaundice, she had been diagnosed with adenomyosis of uterus with menorrhagia. She started receiving oral ibuprofen 300mg twice a day for 2-3 days/month for menalgia, for a total duration of six months. She also had a history of type 2 diabetes. Her clinical examination revealed a soft, non-tender abdomen with a surgical scar and scleral icterus; her spleen was palpable. Laboratory investigation revealed normal blood work-up apart from low levels of haemoglobin. She also showed deranged liver function and an abnormal lipid profile; her electrolyte levels were normal except potassium (3.1 mmol/L). A work-up for viral serology and antibody tests was normal.
The woman's therapy with ibuprofen was discontinued, and she was hospitalised. Additional examinations included...