Abstract: Objective To analyze a case of acute severe liver injury caused by acyclovir (ACV) chewable tablets in order to provide a reference for rational clinical use of this drug. Methods One case of acute severe liver injury induced by ACV chewable tablets in an adult patient was analyzed before the causality between acyclovir exposure and liver injury was assessed based on the clinical course, laboratory findings and temporal association with drug administration. The potential mechanism of drug-induced liver injury related to acyclovir was explored via literature review. Results Prior to hospitalization, the patient was treated with ACV chewable tablets alone. Based on clinical manifestations, laboratory tests, and the temporal correlations with medication, it was determined that the acute severe liver injury in this patient was likely caused by acyclovir chewable tablets. After acyclovir chewable tablets were discontinued and liver-protecting therapy was initiated, the liver function of this patient improved significantly. Conclusion The underlying mechanism of acyclovir-induced hepatotoxicity remains elusive. When acyclovir is used clinically, the risk of drug-induced liver injury needs to be taken into consideration while adverse reactions should be monitored to make medication safer.

Key words: Acyclovir, Chewable Tablets, Liver Injury, Icterus, Adverse Drug Reaction