A Potential Unrecognized Risk for Acute Hepatotoxicity: A Case Report of Fulminant Liver Failure Following Recent Initiation of Allopurinol and Colchicine.

Drug-induced liver injury (DILI) is a leading cause of acute liver failure in the U.S., though allopurinol and colchicine have not been widely associated with fulminant hepatic failure. We present the case of a male in his 50s with chronic kidney disease (CKD) stage III who developed rapid hepatic decompensation shortly after starting allopurinol and colchicine for gout. Within days, he experienced worsening liver function, renal failure, and respiratory distress, ultimately progressing to multiorgan failure and death within 24 hours of hospital admission. A 6 cm esophageal mass was incidentally found on imaging, though its significance remains unclear. Given the temporal relationship between drug initiation and fulminant hepatic failure, this case raises concerns regarding the potential hepatotoxicity of allopurinol and colchicine, particularly in patients with preexisting renal impairment. Increased awareness and early liver function monitoring may be warranted in high-risk patients starting these medications.