Does Genetics Play a Role in Acute Liver Injury After Amoxicillin Exposure?

Amoxicillin-clavulanate has long been associated with drug-induced liver injury (DILI) and although approximately 4 times less common, amoxicillin has also been implicated. Many studies have associated possible genetic factors with susceptibility to DILI, but there is currently no literature with evidence of instances of DILI within the same family. Two sisters presented with similar symptoms and signs of liver injury including jaundice, scleral icterus, abdominal pain, and anorexia with transaminitis and abnormal coagulation studies. Both sisters were started on amoxicillin approximately 2-3 weeks before presentation. They both had progression of the liver injury, and on biopsies, they had similar findings indicative of DILI as well.