Drug-Induced Liver Injury After Zoledronic Acid Infusion and Literature Review

Zoledronic acid, a bisphosphonate, is commonly used to treat and prevent osteoporosis. Here we report a rare case of acute hepatotoxicity after zoledronic acid infusion in a 50-year-old female patient with no preexisting liver disease taking anastrozole and abemaciclib. Only a few hours after her infusion, the patient developed severe body aches, nausea, and abdominal bloating. Laboratory tests revealed an acute liver injury. Acute viral hepatitis workup was negative, and she was subsequently diagnosed with a hepatocellular drug-induced liver injury. Her transaminitis downtrended over the following day and normalized after 11 days. Given this rarely reported side effect, there is a paucity of evidence to guide treatment decisions. The goal of this case report is to increase awareness of this adverse effect, especially among patients taking other potentially hepatotoxic drugs.