Severe Cholestatic Liver Injury Associated With Clopidogrel: A Rare Case of Drug-Induced Liver Injury.

Drug-induced liver injury remains a diagnostic challenge. Clopidogrel, a widely prescribed antiplatelet agent, is rarely associated with hepatotoxicity. We present a case of severe cholestatic liver injury temporally related to clopidogrel use. Extensive evaluation excluded other etiologies, including biliary obstruction, autoimmune hepatitis, primary biliary cholangitis, and viral hepatitis. Liver biopsy demonstrated cholestasis with ductular reaction, and serial liver function tests showed a reproducible pattern of alkaline phosphatase elevation and decline corresponding to clopidogrel administration and withdrawal. This case highlights the importance of considering clopidogrel-induced cholestatic drug-induced liver injury in patients on the medication who develop unexplained cholestasis.