sterile N-Acetylcysteine / Generic mfg. - LARVOL DELTA

Not So Slick: When Neem Oil Ingestion Acute Liver Injury from Neem Oil Ingestion (ACG 2026) - "For his eczema, patient is on pimecrolimus and reported both ingestion and topical application of Neem powder for four weeks prior to admission...Given concern for drug-induced liver injury, the patient was started on intravenous N-acetylcysteine until LFTs have improved by 50%...Given its lipophilic nature, it has a higher absorption and tissue penetration when ingested causing damage to both hepatocytes and biliary canaliculi damage showing an early rise in AST/ALT followed by rise in ALP and bilirubin and bile excretion becomes impaired. When in combination with a secondary assault such as alcohol which increases CYP-mediated toxic metabolite formation and impairs mitochondrial recovery."

Addiction (Opioid and Alcohol) • Atopic Dermatitis • Cardiovascular • Hepatology • Immunology • Liver Failure • Metabolic Disorders

Ticked Liver: An Unusual Case of Severe Ehrlichiosis-Associated Hepatitis (ACG 2026) - "Given the severity of hepatocellular injury, intravenous N-acetylcysteine was initiated, and infectious disease specialists recommended empiric doxycycline while a comprehensive infectious work-up was pursued. This case highlights the importance of maintaining suspicion for tick-borne illness in patients presenting with acute hepatitis in endemic regions. Early recognition based on social history and concomitant cytopenia and empiric doxycycline therapy while awaiting confirmatory testing remain essential to improving outcomes in severe ehrlichiosis."

Clinical • Atrial Fibrillation • Cardiovascular • Congestive Heart Failure • Endocrine Disorders • Heart Failure • Hematological Disorders • Hepatology • Infectious Disease • Inflammation • Leukopenia • Liver Failure • Thrombocytopenia

Herbal but Harmful, Gotu Kola-Induced Acute Liver Failure (ACG 2026) - "He was started on intravenous N-acetylcysteine with a MELD-Na score of 19. Given the rise in herbal supplement use, clinicians must take thorough histories, as use of these products are often underreported. E arly recognition, discontinuation of the supplement, and supportive care are crucial for recovery."

Cardiovascular • CNS Disorders • Cognitive Disorders • Gastrointestinal Disorder • Hematological Disorders • Hepatic Encephalopathy • Hepatology • Immunology • Inflammation • Liver Failure

Steroid-Refractory Immune Checkpoint Inhibitor (ICI) Hepatitis Presenting With DRESS-Like Features: A Diagnostic and Therapeutic Challenge (ACG 2026) - "Case Description/ A previously healthy 21-year-old Caucasian male with stage IIIb Hodgkin lymphoma was treated with ABVD chemotherapy followed by brentuximab and nivolumab. He developed a perirectal abscess, treated with Bactrim and Augmentin...He was discharged on a 4-week prednisone taper...Despite initiating N-acetylcysteine, IV steroids, and empiric antivirals, his liver enzymes worsened (peak AST/ALT >2,000 U/L and Bilirubin >3mg/dL)...Given the temporal association with ICI exposure, steroid refractory ICI hepatitis was diagnosed, and mycophenolate mofetil 1000mg twice daily was initiated with rapid normalization of liver enzymes...A cytokeratin 7 immunohistochemical was used to highlight native bile ducts and focal ductular reaction. Additional immunohistochemical stains for cytomegalovirus and herpes simplex virus 1/2 and Epstein-Barr Virus-Encoded Small RNAs (EBER) in situ hybridization were negative."

Checkpoint inhibition • Autoimmune Hepatitis • Cholestasis • Cytomegalovirus Infection • Eosinophilia • Epstein-Barr Virus Infections • Fibrosis • Hematological Malignancies • Hepatology • Herpes Simplex • Hodgkin Lymphoma • Immunology • Inflammation • Liver Failure • Lymphoma • Oncology • Vasculitis

Acetaminophen-Induced Hepatocellular Injury Despite Therapeutic Serum Acetaminophen Levels (ACG 2026) - "She reported recent oxycodone-acetaminophen use after a dental procedure and additional acetaminophen intake of approximately 4 g daily, with chronic alcohol use...Intravenous N-acetylcysteine was initiated for suspected acetaminophen-induced liver injury, resulting in rapid improvement in liver enzymes within 24 hours and continued recovery through discharge, without encephalopathy or acute liver failure This case highlights the limitations of relying solely on serum acetaminophen concentrations to exclude toxicity...Clinicians should maintain a high index of suspicion for acetaminophen toxicity in patients presenting with marked aminotransferase elevation and a compatible medication history, even when serum levels are non-toxic. Early initiation of NAC remains a low-risk, potentially lifesaving intervention that may prevent progression to acute liver failure and improve clinical outcomes."

Addiction (Opioid and Alcohol) • CNS Disorders • Gastroesophageal Reflux Disease • Gastrointestinal Disorder • Hepatology • Immunology • Liver Failure • Metabolic Dysfunction-Associated Steatohepatitis • Pancreatitis

A Sharp Turn: Severe Acute Hepatitis B After Presumed Acupuncture Exposure (ACG 2026) - "She received tenofovir and 5 days of intravenous N-acetylcysteine, with transient improvement followed by worsening bilirubin and international normalized ratio...She continued tenofovir alafenamide...Mild hepatosplenomegaly. Figure: Edema of the duodenum and pancreatic head as well as right upper paracolic gutter."

Addiction (Opioid and Alcohol) • Beta-Thalassemia • CNS Disorders • Genetic Disorders • Hematological Disorders • Hepatitis B • Hepatology • Infectious Disease • Inflammation • Liver Failure

Hyperacute Liver Injury After Proline-Stabilized IVIG: A Rare Non-Acetaminophen DILI Successfully Treated With N-Acetylcysteine (ACG 2026) - "We present a unique case of hyperacute Privigen-induced hepatitis in a young female with Myasthenia Gravis (MG), which rapidly resolved following an NAC infusion. Case Description/ A 20-year-old female with a history of generalized Myasthenia Gravis (on maintenance prednisone, pyridostigmine, and mycophenolate mofitil) was admitted for a myasthenic crisis presenting with bulbar symptoms and bilateral lower extremity weakness...Although the mechanism is unclear, IV Nâacetylcysteine may accelerate recovery in nonâacetaminophen IVIG hepatotoxicity. Early recognition can avoid unnecessary liver biopsy and supports a safe, effective management approach. Figure: Figure: Trending liver enzymes and bilirubin"

Autoimmune Hepatitis • CNS Disorders • Hepatology • Human Immunodeficiency Virus • Immunology • Infectious Disease • Inflammation • Liver Failure • Myasthenia Gravis

Biliary Mirage: Herb-Induced Acute on Chronic Liver Failure Masquerading as Acute Choledocholithiasis (ACG 2026) - "Given worsening hyperbilirubinemia, an INR increase to 1.9, and hyperammonemia, IV N-acetylcysteine was administered for 72 hours and LT evaluation was initiated...She received a 3 day course of 60 mg IV methylprednisolone, followed by oral prednisone for 30 days with taper due to lack of improvement...Figure: Figure 1. Liver biopsy: Severe hepatitis with marked pericentral necrosis and cholestasis."

Cholestasis • Gastroenterology • Hepatology • Inflammation • Liver Failure

Acute Hepatocellular Drug-induced Liver Injury following Cosmetic Liquid Lipo Injection Complicated by Anaphylactic Reaction to N-acetylcysteine. (PubMed, Ann Afr Med) - "Intravenous N-acetylcysteine (NAC) was initiated for suspected severe DILI, but the patient developed an acute anaphylactic reaction requiring discontinuation of the infusion and treatment with epinephrine, diphenhydramine, and methylprednisolone. Cosmetic liquid lipo injection may be associated with severe hepatocellular DILI. Clinicians should obtain a detailed cosmetic procedure exposure history in unexplained acute liver injury and remain alert to hypersensitivity reactions during intravenous NAC therapy."

Journal • Aesthetic Medicine • CNS Disorders • Cytomegalovirus Infection • Dermatology • Epstein-Barr Virus Infections • Hepatology • Human Immunodeficiency Virus • Immunology • Infectious Disease • Liver Failure • Pruritus

A rare rosuvastatin-clarithromycin interaction presenting with acute liver injury and delayed rhabdomyolysis. (PubMed, Indian J Pharmacol) - "Withdrawal of both agents, along with supportive treatment with intravenous N-acetylcysteine and ursodeoxycholic acid led to a rapid biochemical improvement. The patient subsequently died due to refractory shock related to his critical illness, and death was not directly attributed to the suspected drug-drug interaction. This case highlights a rare but clinically important interaction between rosuvastatin and macrolides that may be under-recognized, particularly in the elderly or critically ill patients."

Journal • Cardiovascular • Coronary Artery Disease • Heart Failure • Hepatology • Infectious Disease • Liver Failure • Respiratory Diseases

The Efficacy of N-acetylcysteine as an Adjunct in the Management of Acute Zinc Phosphide Poisoning: A Randomized Double-Blind Controlled Trial. (PubMed, Cureus) - "This study aimed to evaluate whether intravenous N-acetylcysteine (NAC) can improve clinical outcomes when added to standard supportive care. Conclusions In this preliminary single-center trial, adjunctive intravenous NAC was not associated with a statistically significant reduction in in-hospital mortality or the requirement for inotropic support; however, a clinically meaningful trend was observed. Larger multicenter randomized trials are needed to determine the role of NAC in acute zinc phosphide poisoning."

Clinical • Journal • Metabolic Disorders

Delayed-Onset Hepatocellular Liver Injury Associated With Nitrofurantoin and Herbal Supplement Use: A Case Report With Multiple Potential Exposures. (PubMed, Case Rep Gastrointest Med) - "The patient received intravenous N-acetylcysteine emergently after removing all suspected hepatotoxic substances from her treatment plan. N-acetylcysteine was administered empirically due to concern for progression, although its role in nonacetaminophen DILI remains uncertain. The case demonstrates that clinicians should evaluate for polysubstance-induced liver damage when patients present with multiple possible liver-damaging substances."

Journal • Autoimmune Hepatitis • Hepatology • Immunology • Infectious Disease • Inflammation • Liver Failure • Metabolic Dysfunction-Associated Steatotic Liver Disease • Nephrology

Spectrum of Hepatic Manifestation in Neonatal Dengue: A Case Report. (PubMed, Sage Open Pediatr) - "The baby was successfully managed with intravenous N-acetylcysteine for dengue-associated hepatitis and methylprednisolone for refractory thrombocytopenia, resulting in dramatic clinical improvement. Subsequently, he developed prolonged cholestasis, and by day 36, ultrasound showed hepatic dystrophic calcifications as post-infective sequelae, highlighting the need for vigilance and prolonged follow-up."

Journal • Cholestasis • Dengue Fever • Hematological Disorders • Hepatology • Inflammation • Thrombocytopenia

Severe Acute Liver Injury Following Repeated Supratherapeutic Paracetamol Ingestion in a Child: A Case Report from a Resource-Limited Setting. (PubMed, Int Med Case Rep J) - "Based on the clinical history and biochemical findings, intravenous N-acetylcysteine therapy was started promptly. It highlights the importance of obtaining a careful medication history, recognizing the limitations of serum drug levels in such situations, and starting N-acetylcysteine promptly when repeated supratherapeutic ingestion is suspected. It also reinforces the need to improve caregiver awareness of safe dosing practices."

Journal • Hepatology • Liver Failure • Pain • Pediatrics

Clinically Suspected Acute Post-Measles Encephalitis Complicated by Paracetamol-Induced Hepatotoxicity in an Unvaccinated Child: A Case Report from a Resource-Limited Setting. (PubMed, Infect Drug Resist) - "The patient was treated with supportive intensive care, empirical antimicrobial and antiviral therapy, vitamin A, intracranial pressure management, and intravenous N-acetylcysteine, with complete neurological recovery. Acute post-measles encephalitis should be considered in unvaccinated children who develop new neurological symptoms after recent measles illness. This case highlights the importance of early clinical recognition, routine measles immunization, and safe fever management, including careful weight-based paracetamol dosing and caregiver counseling in resource-limited settings."

Journal • CNS Disorders • Conjunctivitis • Cough • Critical care • Epilepsy • Hematological Disorders • Infectious Disease • Measles • Ocular Infections • Ocular Inflammation • Ophthalmology • Respiratory Diseases

From hepatitis A to acute liver failure in a resource-limited setting: a case report. (PubMed, IJID Reg) - "In the absence of liver transplantation or continuous renal replacement therapy, a resource-adapted supportive bundle was implemented, including intravenous N-acetylcysteine, vitamin K, neuroprotection, glucose control, early enteral nutrition, conservative transfusion, and infection surveillance. Clinical and biochemical parameters improved, and she was discharged after approximately 4 weeks, with recovery on follow-up. This case highlights early warning signs and the feasibility of a structured non-transplant management pathway for HAV-associated ALF in constrained settings."

Journal • CNS Disorders • Hepatic Encephalopathy • Hepatology • Infectious Disease • Inflammation • Liver Failure • Transplantation

A Study of N-acetylcysteine in Patients With COVID-19 Infection (clinicaltrials.gov) - P2 | N=48 | Active, not recruiting | Sponsor: Memorial Sloan Kettering Cancer Center | Trial completion date: May 2026 ➔ May 2027 | Trial primary completion date: May 2026 ➔ May 2027

Trial completion date • Trial primary completion date • Infectious Disease • Novel Coronavirus Disease

Silica Promotes Silicosis via the ROS/NF-κB p65 Signaling-Activated Hypoxia-Lactate Axis in Rats. (PubMed, J Appl Toxicol) - "Then the rats in intervention groups received daily intravenous injections of N-acetylcysteine (NAC) (at doses of 20, 40, and 80 mg/kg, respectively) while the rats in control and model groups received PBS injections. When NAC was employed to inhibit silica-induced ROS, all of the above phenomena were reversed in a dose-dependent manner. These findings indicated that silica induced pulmonary hypoxia via the ROS/NF-κB p65 pathway, which subsequently triggered inflammation and fibrosis through lactic acid fermentation, ultimately leading to silicosis."

Journal • Preclinical • Fibrosis • Immunology • Inflammation • Pulmonary Disease • Respiratory Diseases • HIF1A • IL1B • LDHA • SLC2A1 • TGFB1

Cerebral Edema and Brain Death Following Intravenous N-Acetylcysteine Overdose: A Case Report. (PubMed, Can J Physiol Pharmacol) - "They were treated with lorazepam, phenytoin, intubation, and propofol. Investigations including lumbar puncture and post-mortem toxicology analysis was unremarkable. Clinicians must be aware of the clinical features of supratherapeutic IV NAC dosing errors and potential adverse effects."

Journal • CNS Disorders • Epilepsy

Host-directed nanotherapy for the treatment and imaging of tuberculous meningitis. (PubMed, Theranostics) - "For therapy, rabbits with TB meningitis (i.e., infected) received weekly intravenous dendrimer-N-acetyl cysteine (D-NAC) or phosphate buffered saline (PBS)...Post-mortem analyses corroborated these findings, demonstrating that D-NAC reduced microglial inflammation and IL-17a levels, while improving myelination and BBB integrity. This study establishes D-NAC as a promising host-directed theranostic strategy for TB meningitis and supports the clinical potential of dendrimer nanoplatforms to diagnose and treat central nervous system infections."

Journal • CNS Disorders • Infectious Disease • Inflammation • Vascular Neurology • IL17A

Severe Hepatocellular Injury With Transaminases > 20,000 IU/L in Suspected Repeated Drug Ingestion Despite Undetectable Serum Levels. (PubMed, Cureus) - "Intravenous N-acetylcysteine was initiated despite the undetectable level. Liver enzymes subsequently improved, and the patient remained hemodynamically stable without encephalopathy. This case highlights that an undetectable acetaminophen level does not exclude severe toxicity and emphasizes the importance of early empiric treatment when clinical suspicion is high."

Journal • Addiction (Opioid and Alcohol) • CNS Disorders • Hepatology • Liver Failure • Pain • Pancreatitis

TRANSPLANTATION-ASSOCIATED THROMBOTIC MICROANGIOPATHY: INCIDENCE AND MANAGEMENT IN SETTINGS WITH LIMITED BIOMARKERS AND NO ACCESS TO TARGETED THERAPIES (EBMT 2026) - "Conditioning regimens were TBI or Busulfan iv-based. Graft versus host disease (GVHD) prophylaxis consisted on cyclosporine and short course of methotrexate +/- ATG...EASIX score was significantly higher in patients with TA-TMA compared to patients without TA-TMA, at day 30, day 100 and at last follow-up (p<10-3,<10-3 and 0.022, respectively).In multivariate analysis, acute GVHD and microbiologically documented fever were significantly associated with TA-TMA (p= 0.048 and 0.032, respectively).Cyclosporine was discontinued in all cases of TA-TMA and switched to mycophenolate mofetil...None patient received plasma exchange and one patient received iv N-acetylcysteine... In our experience, the TA-TMA was associated with a high NRM. Early monitoring using plasma sC5b-9 levels and access to targeted therapies are essential."

Biomarker • Acute Graft versus Host Disease • Acute Respiratory Distress Syndrome • Aplastic Anemia • Bone Marrow Transplantation • Graft versus Host Disease • Hematological Disorders • Immunology • Septic Shock • Transplantation • Transplantation Associated Thrombotic Microangiopathy

TRANSPLANTATION-ASSOCIATED THROMBOTIC MICROANGIOPATHY: INCIDENCE AND MANAGEMENT IN SETTINGS WITH LIMITED BIOMARKERS AND NO ACCESS TO TARGETED THERAPIES (EBMT 2026) - "Conditioning regimens were TBI or Busulfan iv-based. Graft versus host disease (GVHD) prophylaxis consisted on cyclosporine and short course of methotrexate +/- ATG...EASIX score was significantly higher in patients with TA-TMA compared to patients without TA-TMA, at day 30, day 100 and at last follow-up (p<10-3,<10-3 and 0.022, respectively).In multivariate analysis, acute GVHD and microbiologically documented fever were significantly associated with TA-TMA (p= 0.048 and 0.032, respectively).Cyclosporine was discontinued in all cases of TA-TMA and switched to mycophenolate mofetil...None patient received plasma exchange and one patient received iv N-acetylcysteine... In our experience, the TA-TMA was associated with a high NRM. Early monitoring using plasma sC5b-9 levels and access to targeted therapies are essential."

Biomarker • Acute Graft versus Host Disease • Acute Respiratory Distress Syndrome • Aplastic Anemia • Bone Marrow Transplantation • Graft versus Host Disease • Hematological Disorders • Immunology • Septic Shock • Transplantation • Transplantation Associated Thrombotic Microangiopathy

SUCCESSFUL USE OF PLASMA ADSORPTION (DPMAS) AS BRIDGE THERAPY FOR DRUG-INDUCED LIVER INJURY IN A PATIENT WITH PANCREATICOBILIARY TUBERCULOSIS: A CASE REPORT (ISN-WCN 2026) - "Supportive care included intravenous N-acetylcysteine, vitamin K, and albumin infusion. Early recognition of reversible hepatic injury and timely initiation of DPMAS may improve outcomes in high-risk patients, particularly in resource-limited settings or where transplantation is not immediately available. This case highlights the feasibility of using DPMAS as a bridge to recovery in severe DILI."

Case report • Clinical • CNS Disorders • Hematological Disorders • Hepatic Encephalopathy • Hepatology • Infectious Disease • Inflammation • Liver Failure • Respiratory Diseases • Tuberculosis

Acute Liver Failure in Adult-Onset Still Disease: A Diagnostic Challenge (SCCM 2026) - "Although hepatic involvement typically presents as mildly elevated transaminases, in rare cases, it can progress to acute liver failure.Description: 48-year-old female with a new diagnosis of AOSD on high dose prednisone and Bactrim for PJP prophylaxis, presented to the ER with a 3-day history of nausea, vomiting, and abdominal pain...Patient was started on IV N-acetylcysteine, corticosteroids, and atovaquone...After clinical stabilization, patient was discharged with a tapering course of prednisone and continued on atovaquone. This case highlights the challenge of managing acute liver injury in the context of AOSD, which may result from disease itself, AOSD-induced macrophage activation syndrome, or DILI. High clinical suspicion, timely escalation of care to a liver transplant center and a multidisciplinary approach are critical in ensuring a favorable clinical outcome."

Clinical • Autoimmune Hepatitis • Gastroenterology • Gastrointestinal Disorder • Hemophagocytic lymphohistiocytosis • Hepatology • Immunology • Inflammation • Liver Failure • Rare Diseases