A Time to Pause and Reflect: When a Patient with Autoimmune Hepatitis Stops Responding to Corticosteroids

Table 1

Updated RUCAM results for irbesartan.

Items for hepatocellular injury	Score
Time of onset from starting the drug: 5 to 90 days	2
Course of ALT after cessation: decrease 50% within 30 days	2
Risk factors
No alcohol use	1
age > 55 yrs (74)	1
Concomitant drugs/ herbs: none	0
Search for alternative causes: HAV/HBV/HCV negative, hepatobiliary ultrasound normal, no history of alcoholism or recent acute hypotension	0
Previous hepatotoxicity of drug, reaction labelled in the product characteristics	2
Response to unintentional reexposure, doubling of ALT with drug alone	3
Total

score of >9 suggests that irbesartan is highly probable as being the cause of DILI in this case.