Acute Elevation of Liver Enzymes Following Anti-thymocyte Globulin Treatment in a Patient with Aplastic Anemia: A Case Report

is primarily managed through immunosuppression. Anti-thymocyte globulin (ATG), a polyclonal antibody derived from equine or lapine sources, is one such immunosuppressive treatment. While common side effects of ATG include allergic reactions, thrombocytopenia, headache, and myalgia, more severe but less frequent adverse effects encompass dyspnea and chest pain. The incidence and severity of liver function test abnormalities associated with ATG administration remain subjects of ongoing debate; however, most cases present with mild and transient enzyme elevations. Case: We present the case of a 13-year-old male child diagnosed with aplastic anemia (AA) who was admitted to the hematology clinic for ATG treatment. Three days after the initiation of ATG therapy, following the third dose, the patient developed severe hepatotoxicity. The patient experienced symptoms including chest pain, icterus, myalgia, and abdominal tenderness. Laboratory investigations revealed a significant elevation in liver enzymes and serum bilirubin levels. Upon discontinuation of ATG, the symptoms resolved within six days, accompanied by a marked reduction in liver enzymes and bilirubin levels. Subsequently, the patient received the fourth dose of ATG without adverse reactions. Conclusion: Our patient developed frank symptomatic hepatitis, manifesting as icterus and right upper quadrant pain. Given the existing literature, this presentation does not appear to be common and warrants increased vigilance.