Management of Acute Liver Failure Due to Drug–Drug Interactions Usinga Novel Nutraceutical: A Case Report

Background: Drug-Induced Liver Injury (DILI) is a leading cause of acute hepatic impairment. Underlying liver disease, drug–drug interactions, and multiple hepatotoxic exposures can exacerbate injury. Nutraceuticals may have hepatoprotective potential. Case Presentation: A 37-year-old woman with obesity, hypertension, and PCOS presented with epigastric pain. Two weeks prior, she had taken acetaminophen (1,000–2,000 mg/day), levonorgestrel (three days before admission), and mushrooms one day prior. Laboratory tests revealed elevated AST, ALT, γ-GT, and bilirubin. Imaging showed fatty liver and microlithiasis. DILI was diagnosed, attributed primarily to acetaminophen and methyldopa, in the context of Non-alcoholic fatty liver disease. Offending drugs were discontinued; supportive therapy included ursodeoxycholic acid, dietary modifications, and a nutraceutical formulation (Drolessano®) for 3 months. Liver enzymes peaked on day 11 but gradually improved. By day 64, AST, ALT, and γ-GT normalized, total and indirect bilirubin were normal, and direct bilirubin was slightly elevated (0.55 mg/dL). Conclusion: DILI can result from multiple interacting factors, including polypharmacy and underlying liver disease. Prompt withdrawal of hepatotoxic agents and supportive