Fulminant Hepatic Failure Following Initiation of Abiraterone in Metastatic Prostate Cancer: A Fatal Adverse Drug Reaction.

Background: Abiraterone acetate is widely used in metastatic castration-resistant prostate cancer and is generally considered safe. Hepatotoxicity is a known adverse effect, but fulminant liver failure remains a rare and potentially fatal complication. Case presentation: An 80-year-old man with metastatic prostate cancer was admitted with high-grade fever and general deterioration three weeks after initiation of abiraterone in addition to ongoing androgen deprivation therapy. He presented with jaundice, hypotension, and altered mental status. Laboratory investigations revealed severe acute liver injury with markedly elevated transaminases, coagulopathy, hyperbilirubinemia, acute kidney injury, metabolic acidosis, and hypoglycemia. Computed tomography demonstrated marked periportal hepatic edema and mild hilar lymphadenopathy, consistent with severe acute liver injury. No focal hepatic lesions or malignancy were identified. Despite discontinuation of abiraterone and supportive care, there was a progression to multiorgan failure, and the patient died within 48 h of admission. Postmortem investigations excluded acute hepatitis A and cytomegalovirus infection. Epstein-Barr virus serology was consistent with past infection, excluding acute infection. Although histological confirmation was not obtained, the clinical course and temporal association were highly suggestive of drug-induced liver injury. Conclusion: This case highlights a rare but catastrophic adverse reaction to abiraterone. Regular monitoring of liver function and early consideration of hepatotoxicity in patients presenting with systemic symptoms during treatment are essential.