Acute Elevation of Liver Enzymes Following Anti-thymocyte Globulin Treatment in a Patient with Aplastic Anemia: A Case Report

Mahdi Maleki  Aghdam; Negin  Ebrahimpour; Farid  Ghazizadeh; Zahra A  Ghelichkhan

doi:10.18502/jabs.v14i3.16353

Mahdi Maleki Aghdam Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
Negin Ebrahimpour Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
Farid Ghazizadeh Department of Pediatric Hematology, Motahari Hospital, Urmia University of Medical Sciences, Urmia, Iran
Zahra A Ghelichkhan Experimental and Applied Pharmaceutical Sciences Research Center, Urmia University of Medical Sciences, Urmia, Iran

DOI: https://doi.org/10.18502/jabs.v14i3.16353

Keywords: Aplastic anemia, Liver dysfunction, Anti-thymocyte globulin

Abstract

Background & Objective: Plastic anemia, a rare hematological disorder resulting inpancytopenia, is primarily managed through immunosuppression. Anti-thymocyteglobulin (ATG), a polyclonal antibody derived from equine or lapine sources, is onesuch immunosuppressive treatment. While common side effects of ATG include allergicreactions, thrombocytopenia, headache, and myalgia, more severe but less frequentadverse effects encompass dyspnea and chest pain. The incidence and severity of liverfunction test abnormalities associated with ATG administration remain subjects ofongoing debate; however, most cases present with mild and transient enzyme elevations.

Case: We present the case of a 13-year-old male child diagnosed with aplastic anemia (AA) who was admitted to the hematology clinic for ATG treatment. Three days after the initiation of ATG therapy, following the third dose, the patient developed severe hepatotoxicity. The patient experienced symptoms including chest pain, icterus, myalgia, and abdominal tenderness. Laboratory investigations revealed a significant elevation in liver enzymes and serum bilirubin levels. Upon discontinuation of ATG, the symptoms resolved within six days, accompanied by a marked reduction in liver enzymes and bilirubin levels. Subsequently, the patient received the fourth dose of ATG without adverse reactions

Conclusion: Our patient developed frank symptomatic hepatitis, manifesting as icterus and right upper quadrant pain. Given the existing literature, this presentation does not appear to be common and warrants increased vigilance