Idiosyncratic drug-induced liver injury caused by givosiran in a patient with acute intermittent porphyria

A 39-year-old woman with biochemically and clinically active acute intermittent porphyria (AIP) developed moderately severe liver injury after receiving her second dose of givosiran. Serologic evaluation ruled out hepatitis caused by viral, autoimmune, or other metabolic etiologies. The updated Roussel Uclaf Causality Assessment Method (RUCAM) score was 8 and the Revised Electronic Causality Assessment Method (RECAM) score for givosiran was 9. Results of liver tests returned to normal after givosiran was discontinued, and she has not received any more givosiran.