Drug-induced liver injury highly probable due to goserelin: a case report evaluated with the updated RUCAM (2016)

Goserelin is widely used for prostate cancer, but drug-induced liver injury (DILI) has been rarely reported. We present a patient who developed ALT/AST elevations after each subcutaneous injection, followed by improvement after withdrawal and hepatoprotective therapy, with positive rechallenge upon re-exposure. By the EASL definition, the R-value was ≈6.0, indicating a hepatocellular pattern; Hy's law was not fulfilled. Causality assessed with the updated RUCAM (2016) yielded a total score of 11, corresponding to highly probable. Although the ALT peak did not exceed 5 × ULN, the consistent temporal association and positive rechallenge prompted discontinuation/adjustment of goserelin with close biochemical follow-up, achieving a favorable outcome. This case underscores the need for vigilant monitoring-particularly with higher doses or re-exposure-and highlights the utility of R-value typing, Hy's law, and the updated RUCAM in guiding management. Liver biopsy was not performed, representing a limitation.