08 July 2026
: Case report 
A 31-Year-Old Woman With Liver Cirrhosis Due to Wilson Disease and the Double Impact of Active Tuberculosis and Anti-Tuberculosis Therapy Resulting in Acute Liver Injury
Challenging differential diagnosis, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Rare disease, Adverse events of drug therapy, Educational Purpose (only if useful for a systematic review or synthesis)
Petar Trifonov ABEF 1,2*, Sonya Stefkova Dragneva ABEF 1,2, Donika K. Todovichin BDF 1,2, Ivana Tihomirova Kitaeva BE 1, Rosen K. Nikolov ADF 1,2DOI: 10.12659/AJCR.953050
Am J Case Rep 2026; 27:e953050
Table 1 Sequential liver biochemistry across 3 hospital admissions.Aaspartate aminotransferase (AST; reference range 10–40 U/L); alanine aminotransferase (ALT; reference range 7–40 U/L); total bilirubin (reference range 5–17 μmol/L); albumin (reference range 35–50 g/L); international normalized ratio (INR; reference range 0.9–1.2). The steep rise in AST and ALT in September 2025 coincides with the initiation of rifampicin and isoniazid. Antituberculosis drug-induced liver injury, AT-DILI.
| Total bilirubin [μmol/L] | AST [U/L] | ALT [U/L] | INR | |
|---|---|---|---|---|
| February 2025 (baseline) | 22.1 | 45 | 27 | 1.25 |
| July 2025 (LTBI decompensation) | 42 | 60 | 15 | 1.51 |
| September 2025 (AT-DILI) | 84 | 349 | 46 | 1.61 |