Mary Barbara, MD1, Amulya Reddy, DO1, Chinenye Osuorji, MD2, Tushar Gohel, MD, CNSC3 1Midwestern University, Mesa, AZ; 2Burrell College of Medicine, Las Cruses, NM; 3Reddy GI Associates, Gilbert, AZ; Midwestern University, Mountain Vista Medical Center, Mesa, AZ
Introduction: The sodium glucose cotransporter 2 (SGLT-2) inhibitors are used in the management of hyperglycemia in patients with type 2 diabetes mellitus (T2DM). They have not been associated with increases in liver enzymes. Herein, we report a case of 53-year-old female with nonalcoholic fatty liver disease (NAFLD) who developed elevated liver enzymes after using empagliflozin (SGLT-2 inhibitor).
Case Description/Methods: A 53 years old female with a medical history of T2DM, hyperlipidemia and NAFLD was referred to gastroenterology clinic due to elevated liver enzymes. She reported drinking alcohol socially and denied using herbal supplements. Her medications were atorvastatin and metformin. 4 weeks prior to presentation, she started taking empagliflozin 10 mg daily. Physical exam was normal. Laboratory tests one week prior to presentation revealed aspartate transaminase 190 IU/L, alanine transaminase 209 IU/L, alkaline phosphatase 162 IU/L, total bilirubin 0.5 mg/dL, and international normalized ratio 0.9. Liver enzymes two months prior to presentation were normal. Serological markers for acute viral hepatitis were negative. Ferritin, iron saturation, alpha-1-antitrypsin and immunoglobulin levels were within normal limits. Serum antimitochondrial antibody, antinuclear antibody and anti-smooth antibody were negative. Abdominal computed tomography (CT) showed fatty infiltration of the liver. The patient was instructed to stop taking empagliflozin. Laboratory test 4 weeks after stopping empagliflozin revealed aspartate transaminase 38 IU/L, alanine transaminase 49 IU/L, alkaline phosphatase 140 IU/L.
Discussion: Idiosyncratic drug induced liver injury (DILI) is one of the most common causes of elevated liver enzymes. The diagnosis of DILI relies on the exclusion of other etiologies. After ruling out other possible causes of elevated liver enzymes, the diagnosis of empagliflozin induced DILI was made based on the timing of the administration of empagliflozin and the improvement of aminotransferases after the patient stopped taking it. Due to low suspicion of autoimmune hepatitis and the rapid improvement of liver enzymes, liver biopsy was not indicated. No studies have reported hepatotoxicity with the use of SGLT-2 inhibitors. In fact, multiple studies have demonstrated improvement alanine transaminase in type 2 diabetes patients when treated with SGLT-2 inhibitors.To our knowledge, there is only one other case report of acute hepatitis caused by empagliflozin in a nonalcoholic fatty liver disease patient.
Disclosures: Mary Barbara indicated no relevant financial relationships. Amulya Reddy indicated no relevant financial relationships. Chinenye Osuorji indicated no relevant financial relationships. Tushar Gohel indicated no relevant financial relationships.
Mary Barbara, MD1, Amulya Reddy, DO1, Chinenye Osuorji, MD2, Tushar Gohel, MD, CNSC3. P0848 - Elevated Liver Enzymes Caused by Empagliflozin in a Nonalcoholic Fatty Liver Disease Patient, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
