03 February 2026
: Case report 
Drug-Induced Liver Injury Associated With the Angiotensin II Receptor Blocker Losartan in a 59-Year-Old Woman With Hypertension: A Case Report
Unusual clinical course, Challenging differential diagnosis, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Adverse events of drug therapy
Ahmad Al-Ajaj
BDE 1*, Wissem Melki E 1
DOI: 10.12659/AJCR.949256
Am J Case Rep 2026; 27:e949256
Table 1 Initial clinical presentation, laboratory results, and radiology investigations at presentation.
| Initial symptoms | Belching, right-sided back pain, right upper quadrant discomfort, and dyspepsia for the past 3 months |
| Vital signs | Blood pressure, 119/59 mmHg; pulse, 90 beats/min; respiratory rate, 18 breaths/min; temperature, 36°C; oxygen saturation, 99%; body mass index, 27.2 kg/m (slightly elevated) |
| Clinical examination | Nasal septum deviation and mild tenderness noted in the right upper quadrant. Cardiovascular, respiratory, and neurological examinations all normal, including ophthalmology evaluation |
| Liver function tests | ALT, 640 IU/L (12–78 IU/L); AST, 341 IU/L (15–37 IU/L); ALP, 247 IU/L (45–117 IU/L); total bilirubin, 5.5 μmol/L (3.0–17.0 μmol/L); direct bilirubin, 3.0 μmol/L (0–8.6 μmol/L); prothrombin time, 12 s (11–13.5 s); international normalized ratio, 1.0 (0.8–1.2); serum albumin, 37 g/L (34–50 g/L) |
| Lipid profile | Total cholesterol, 6.6 mmol/L (0.00–5.18 mmol/L); triglycerides, 0.99 mmol/L (0.00–1.95 mmol/L); high-density lipoprotein, 1.99 mmol/L (1.03–1.55 mmol/L); low-density lipoprotein, 4.17 mmol/L (0.00–3.3 mmol/L) |
| Thyroid stimulating hormone | 1.11 μIU/mL (0.55–4.78 μIU/mL) |
| Fasting blood glucose | 5.7 mmol/L (4.1–5.9 mmol/L) |
| Creatinine | 50 μmol/L (53–115 μmol/L) |
| Electrolytes | Sodium, 137 mmol/L (136–144 mmol/L); potassium, 3.8 mmol/L (3.6–5.1 mmol/L); corrected calcium, 2.5 mmol/L (2.23–2.58 mmol/L); magnesium, 0.85 mmol/L (0.74–0.99 mmol/L) |
| C-reactive protein | 5 (<3 mg/L) |
| Urinalysis | Within normal limits: proteins, negative; glucose, negative; bilirubin, negative |
| Hepatitis A, B, C, and E; cytomegalovirus; Epstein-Barr virus; herpes simplex virus | Negative |
| Anti-mitochondrial antibodies | Negative |
| Autoimmune hepatitis screen | Anti-liver kidney microsomal antibody, negative; anti-smooth muscle antibodies, negative; anti-nuclear antibodies, negative |
| Helicobacter pylori urea breath test | Negative |
| Complete blood count | Within normal limits |
| Ferritin | 115 ng/mL (normal) |
| Malaria blood smear | Negative |
| Radiology | Abdominal ultrasound, normal; magnetic resonance cholangiopancreatography, normal |
| ALT – alanine aminotransferase; AST – aspartate aminotransferase; ALP – alkaline phosphatase. | |