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Transient serum enzyme elevations could be observed during therapy, but clinically significant acute liver injury has been rarely associated with its use. Few cases of acute liver injury have been reported in the literature. We reported the clinical case of a 73--year-old man who developed clinically significant acute hepatic injury after using gemcitabine. Possible causes, clinical presentation, and treatments are discussed. According to the updated RUCAM score, the case was rated 10 points and became a suspected drug-induced liver injury. Moreover, on the liver biopsy, there were histological findings of mild-to-moderate portal hepatitis, eosinophilia, bile duct injury, and mild perisinusoidal fibrosis, suggesting drug damage.<\/jats:p>","DOI":"10.1155\/2020\/8812983","type":"journal-article","created":{"date-parts":[[2020,10,5]],"date-time":"2020-10-05T22:35:09Z","timestamp":1601937309000},"page":"1-5","source":"Crossref","is-referenced-by-count":5,"title":["A Severe Case of Drug-Induced Liver Injury after Gemcitabine Administration: A Highly Probable Causality Grading as Assessed by the Updated RUCAM Diagnostic Scoring System"],"prefix":"10.1155","volume":"2020","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0945-4960","authenticated-orcid":true,"given":"Ilenia","family":"Mascherona","sequence":"first","affiliation":[{"name":"Ospedale La Carit\u00e0, Medicina Interna, Locarno, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caterina","family":"Maggioli","sequence":"additional","affiliation":[{"name":"AUSL di Bologna, Ospedale di Budrio, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maira","family":"Biggiogero","sequence":"additional","affiliation":[{"name":"Clinica Luganese Moncucco, Unit\u00e0 di Ricerca Clinica, Lugano, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oreste","family":"Mora","sequence":"additional","affiliation":[{"name":"Clinica Luganese Moncucco, Oncologia Medica, Lugano, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Marelli","sequence":"additional","affiliation":[{"name":"Clinica Luganese Moncucco, Oncologia Medica, Lugano, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","reference":[{"key":"1","doi-asserted-by":"publisher","DOI":"10.1007\/s00280-003-0661-5"},{"key":"2","doi-asserted-by":"publisher","DOI":"10.1007\/s00280-007-0474-z"},{"key":"3","first-page":"1783","article-title":"Acute liver injury with hepatic encephalopathy associated with gemcitabine administration for adjuvant chemotherapy in an HBV carrier with pancreatic cancer","volume":"37","author":"H. 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