Delayed onset drug-induced acute liver failure associated with Glatiramer acetate use in multiple sclerosis requiring liver transplantation

Glatiramer acetate (GA) has been used for the treatment of relapsing multiple sclerosis (MS) since 1996. We describe a 59-year-old woman with well-controlled MS on long-term GA who presented with three weeks of jaundice and dark-colored urine and elevated liver enzymes and had biopsy-proven drug induced liver injury. The patient underwent expedited liver transplant evaluation and successfully underwent deceased donor liver transplant. Our case illustrates the first case of acute liver failure (ALF) associated with Glatiramer acetate use requiring liver transplantation. Patients on GA should have long term regular liver monitoring.