Etoricoxib-associated liver injury in a 67-year-old man: a case report

INTRODUCTION: Over the last two decades, the number of recorded cases of drug-induced liver injury (DILI) has increased 30-fold, which is directly related to the expansion of the drug arsenal on the pharmaceutical market. According to statistics, DILI is diagnosed in 3% of patients in Russia, whereas abroad this rate is 10–20 cases per 100,000 population. Furthermore, about 40,000 deaths due to DILI are recorded annually worldwide.

The medical scientific community has described numerous common “culprits” of hepatotoxicity. We would like to highlight a clinical case of DILI in a 67-year-old man associated with etoricoxib use. Cyclooxygenase-2-selective non-steroidal anti-inflammatory drugs (NSAIDs) rarely affect the liver, making this case non-standard and, therefore, difficult to predict. However, the consequences of NSAID-induced liver damage are often serious: fulminant hepatic failure and hepatorenal syndrome. In this regard, only a physician’s vigilant attention to the drugs taken by the patient, as well as the ability to recognize drug-induced conditions using diagnostic tests as early as possible, can stop a prolonged, asymptomatic, life-threatening toxic process.

CASE DESCRIPTION: This article describes a clinical case of DILI in a 67-year-old man associated with etoricoxib use. On the morning of the second day of planned hospitalization for blood pressure adjustment, the patient began to complain of weakness and epigastric pain. A detailed physical examination revealed icteric sclera. The therapeutic approach included laboratory tests, differential diagnosis, and therapeutic measures. After the diagnosis of DILI was established, the causative drug was discontinued and adequate therapy was administered, leading to an improvement in laboratory parameters and the patient’s condition.

CONCLUSION: Drug-induced liver injury remains a pressing clinical and diagnostic problem in modern medicine. Even drugs that are considered safe and widely used in clinical practice can cause liver damage under certain conditions. Individual drug interaction profiles and treatment duration can increase the risk of hepatotoxicity. Therefore, no drug can be considered completely harmless to the liver, highlighting the need for rational prescribing, liver function monitoring, and careful attention to possible adverse effects of medications.