Supplementary Material for: 5-Aminosalicylic Acid-Induced Liver Injury in a Patient with Ulcerative Colitis: A Case Report

<b><i>Introduction:</i></b> Drug-induced liver injury (DILI) associated with 5-aminosalicylic acid (5-ASA) is a rare but potentially life-threatening adverse event. <b><i>Case Presentation:</i></b> We report the case of a 58-year-old woman with ulcerative colitis who developed DILI after initiating maintenance therapy with the multimatrix system 5-ASA. The patient presented with grade 4 liver enzyme elevation on day 98 after initiating 5-ASA and was admitted to the hospital. Blood tests revealed the mixed liver injury, and imaging studies showed no abnormalities except for mild lymph node enlargement. Liver biopsy revealed acute lobular hepatitis with interfacial activity. The patient’s score on the International Autoimmune Hepatitis Group 1999 revised scoring system was a total score of 10, causing a suspicion for the diagnosis of autoimmune hepatitis. The DDW-J 2004 scale calculated a total score of six, indicating a high probability of DILI. We suspected DILI due to 5-ASA, and the 5-ASA formulations were discontinued. The patient was treated with ursodeoxycholic acid and neominophagen C, and her liver function gradually improved without steroid treatment. Finally, we definitively diagnosed DILI based on the pathological findings and clinical course after discontinuation of 5-ASA. <b><i>Conclusion:</i></b> This case highlights the importance of monitoring liver function in patients receiving 5-ASA therapy.

<b><i>引言：</i></b> 与5-氨基水杨酸（5-ASA）相关的药物性肝损伤（DILI）是一种罕见但可能危及生命的不良事件。<b><i>病例报告：</i></b> 本文报告1例58岁溃疡性结肠炎女性患者，在起始接受多基质系统型5-ASA维持治疗后发生DILI。患者于启用5-ASA治疗后第98天出现4级肝酶升高并入院。血液检查提示为混合性肝损伤，影像学检查未见明显异常，仅见轻度淋巴结肿大。肝活检结果显示伴界面炎的急性小叶性肝炎。该患者的国际自身免疫性肝炎小组1999年修订评分量表总分为10分，疑诊自身免疫性肝炎。采用DDW-J 2004量表评分，总分为6分，提示DILI可能性较高。临床考虑为5-ASA相关性DILI，遂停用5-ASA制剂。予熊去氧胆酸及复方甘草酸苷（Neominophagen C）治疗，患者未接受糖皮质激素治疗，肝功能逐渐恢复。最终结合病理结果及停药后的临床病程，明确诊断为DILI。<b><i>结论：</i></b> 本案例凸显了对接受5-ASA治疗的患者开展肝功能监测的重要性。