Febuxostat-induced hepatocellular injury

Febuxostat is a non-purine xanthine oxidase inhibitor primarily used to treat gout and hyperuricaemia. Although it has a better safety profile compared to allopurinol, febuxostat has been associated with rare cases of drug-induced liver injury. We present a case of a man in his late 50s who developed liver injury after switching from allopurinol to febuxostat for gout management. The patient experienced fatigue, nausea, jaundice and had notably elevated aminotransferase activities. A liver biopsy revealed moderate acute hepatocellular injury. After discontinuing febuxostat, the liver tests did not improve for 1 month until treatment with prednisone. This case adds to the existing literature on febuxostat-induced liver injury and highlights the variability in clinical and histological manifestations. It also emphasises the importance of monitoring liver tests in patients taking febuxostat.