Purpose. To report a case of biopsy-confirmed pravastatin-induced liver injury in a patient with nonalcoholic fatty liver disease (NAFLD). Second, to review the data regarding hydroxymethylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) use in patients with NAFLD and monitoring that may be required for statin therapy. Literature Search. A PubMed search and review of the reference lists of the articles included in the case report was performed to find human studies from 1965 to the present on statin therapy in patients with NAFLD. To the authors' knowledge, there are no other case reports that parallel the one presented here. Case Report. A 71-year-old female with NAFLD, challenged multiple times on different lipid lowering agents, with a history of elevated liver enzymes post statin therapy, developed drug-induced hepatocellular damage following pravastatin therapy. Discussion. Symptomatic liver injury with statin therapy is rare even in patients with NAFLD. To the authors' knowledge, there are no case reports demonstrating statin-induced hepatocellular damage in a patient with NAFLD. Conclusion. Contrary to numerous pilot studies indicating the benefit and safety of statin therapy in patients with NAFLD, the authors report a patient case with underlying NAFLD that developed drug-induced liver injury post statin therapy. This case highlights the importance of identifying when symptoms associated with liver injury are occurring in patients with comorbid NAFLD, instead of solely relying on routine monitoring of transaminase levels. Health care providers need to closely examine and question NAFLD patients who develop liver enzyme elevations while on statin therapy to determine if they are showing signs of significant liver dysfunction and obtain more detailed laboratory assessments such as indirect bilirubin and prothrombin time. If hepatotoxicity occurs, the statin should be stopped immediately and treated with an alternative lipid-lowering agent per the National Lipid Association Statin Safety Assessment Task Force recommendations.
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