Pegloticase-Associated Hemolysis.

include nausea (;20%), diarrhea (12%), vomiting (;5%), dyspepsia, and acute pancreatitis (0.1%– 0.3%). There have been no published reports of hepatotoxicity. And in large clinical trials, liver enzyme elevations did not occur at a higher rate than placebo or comparator agents.2,3 To our knowledge, this is the first reported instance of clinically apparent liver injury due to dulaglutide use. Although there have been no previously published case reports of acute liver injury due to dulaglutide therapy, routine monitoring of liver tests may be warranted for patients who are started on this medication, especially in the setting of pre-existing liver disease such as nonalcoholic fatty liver disease or viral hepatitis. Establishing a diagnosis of druginduced liver injury includes a thorough history of medication use and absence of competing causes such as autoimmune hepatitis and viral hepatitis. In certain situations, a liver biopsy may help elucidate the etiology of liver injury. Health care providers should be aware of and educate their patients about any potential risks including drug-induced liver injury reported with use of dulaglutide and similar agents in its class. Anish Vinit Patel, MD Pooja Mahesh Jotwani, MBBS Tai-Ping Lee, MD Division of Gastroenterology Zucker School of Medicine at Hofstra/Northwell New Hyde Park, NY Department of Medicine Byramjee Jeejeebhoy Government Medical College Pune, India Sandra Atlas Bass Center for Liver Diseases Zucker School of Medicine at Hofstra/Northwell Manhasset, NY