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CASE REPORT article
Front. Pharmacol.
Sec. Pharmacogenetics and Pharmacogenomics
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1564124
The role of endoplasmic reticulum aminopeptidase ERAP2 pathogenic mutation rs1363907 in amoxicillin clavulanate-induced liver injury: A Special Case Report
Provisionally accepted- 1Xiangya Hospital, Central South University, Changsha, China
- 2Central South University, Changsha, Hunan Province, China
- 3Hunan Provincial People's Hospital, Changsha, Hunan Province, China
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Idiosyncratic hepatotoxicity is a type of drug-induced liver injury (DILI) that is unpredictable and clinically severe, and amoxicillin-clavulanate (AC) is the most implicated drug in DILI worldwide.The clinical manifestations of amoxicillin clavulanate-induced liver injury (AC-DILI) are fatigue and jaundice, which some allergic features may accompany, but autoimmune phenomena are uncommon.Here, we describe a special case report of a patient with AC-DILI accompanied by autoimmune phenomena for the first time. The patient was a middle-aged Chinese woman who developed liver damage after taking AC for a period of time, with a RUCAM score of 6. The patient tested positive for antinuclear antibodies and had elevated levels of IgG. HLA targeted sequencing results showed that the patient did not carry known AC-DILI-related HLA polymorphisms, but Sanger sequencing suggested that the patient had the ERAP2 rs1363907 mutation, which may be a pathogenic factor of AC-DILI in the patient. The patient's progress notes, disease diagnosis and treatment are summarized, and the role of ERAP2 pathogenic mutation rs1363907 in AC-DILI is discussed.
Keywords: AC-DILI, Idiosyncratic hepatotoxicity, ERAP2, HLA polymorphism, Autoimmune phenomena
Received: 21 Jan 2025; Accepted: 15 Apr 2025.
Copyright: © 2025 Yin, Zhan, Liao, Ye, Zhang and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Ji-Ye Yin, Xiangya Hospital, Central South University, Changsha, China
Zheng Zhang, Hunan Provincial People's Hospital, Changsha, 410005, Hunan Province, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.