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Key Clinical Message: Clinicians in tuberculosis and dengue endemic regions should have heightened vigilance for drug‐induced liver injury (DILI) overlapping with active infections, enabling prompt recognition and life‐saving conservative management. Severe dengue and drug‐induced liver injury (DILI) are significant independent risk factors for acute liver failure. The co‐occurrence of these conditions significantly complicates clinical management. Here, we describe the case of a 21‐year‐old Nepali female who developed acute liver failure during antitubercular therapy (ATT). The patient, presenting with fever and nausea after 3 weeks of ATT, subsequently received a diagnosis of severe dengue. Laboratory evidence indicated markedly elevated transaminases (AST 4335 U/L, ALT 1958 U/L), total bilirubin (72 μmol/L), and INR (>5). Prompt discontinuation of first‐line ATT, initiation of a modified ATT regimen, and N‐acetylcysteine (NAC) infusion facilitated the patient's recovery after a week of intensive care. This case underscores the potential for synergistic hepatotoxicity in regions where multiple endemic illnesses coincide. Early recognition of DILI, cessation of offending agents, and comprehensive intensive care are crucial interventions. While the definitive efficacy of NAC remains under investigation, its timely administration in these complex cases warrants exploration for its potential lifesaving benefits.

Amiodarone, a widely utilized and effective class III antiarrhythmic agent, carries a significant risk of severe organ toxicities, notably including the pulmonary system. This report details a case of an 82‐year‐old female who developed amiodarone‐induced pulmonary toxicity (APT) following 2 years of standard 200 mg daily maintenance therapy for atrial fibrillation. The patient presented with progressive dyspnea, non‐productive cough, and new‐onset oxygen dependency. Diagnostic evaluation, including chest computed tomography revealing diffuse interstitial opacities, alongside the systematic exclusion of other etiologies, confirmed the diagnosis. Prompt discontinuation of amiodarone and initiation of corticosteroid therapy resulted in clinical stabilization. This case underscores the insidious nature of amiodarone‐induced adverse effects, particularly in the elderly population, and reinforces the critical necessity for a high index of clinical suspicion and vigilant, proactive monitoring strategies to facilitate early detection and appropriate management of this potentially life‐threatening iatrogenic complication, even with standard therapeutic dosages.

A document by Nishan Shrestha. Click on the document to view its contents.