Semaglutide Triggers Acute-on-Chronic Liver Failure in Patient with Undiagnosed Chronic Hepatitis B

Semaglutide, a long-acting glucagon-like peptide-1 (GLP-1) receptor agonist, is widely prescribed for type 2 diabetes mellitus and obesity. While common adverse drug reactions (ADRs) typically involve gastrointestinal issues like nausea and vomiting, liver function-related ADRs are considered rare. This rarity creates a critical knowledge gap regarding the potential for severe hepatic complications, particularly in vulnerable populations, which this case report aims to address by documenting a severe instance of drug-induced liver injury.

This case report details a 47-year-old male patient with a history of chronic hepatitis B who had discontinued antiviral therapy over two years prior. Seeking weight loss, he initiated subcutaneous semaglutide therapy. Approximately three months after starting treatment, he presented with severe liver dysfunction. The patient was admitted to the Department of Infectious Disease, where a diagnosis of drug-induced liver injury (DILI) progressing to acute-on-chronic liver failure (ACLF) was made based on clinical presentation and laboratory findings.

The patient's liver dysfunction rapidly progressed to profound jaundice, coagulopathy, and hepatic encephalopathy, consistent with severe ACLF. Drug-induced liver injury was identified as the primary precipitating factor. Following the confirmed diagnosis, semaglutide was immediately discontinued. A comprehensive management strategy was implemented, including hepatoprotective therapy, artificial liver support, and plasma exchange. This aggressive intervention proved successful.

The patient's clinical symptoms and liver function parameters improved significantly after discontinuing semaglutide and initiating intensive supportive care, leading to a successful recovery.