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Drug-induced liver injury: case report A 34-year-old man developed drug-induced liver injury (DILI) during treatment with cefoperazone/sulbactam and levofloxacin for pulmonary infection. On 12 November 2018, the man was hospitalised with fatigue and abdominal distension for 10 days and yellow staining of skin and sclera for 3 days. He had developed loss of appetite 10 days previously. He had treated himself with omeprazole, Lactobacillusbifidus [live combined bifidobacterium] and itopride, without any improvement of the symptoms. He had further developed nausea and greasiness-weariness along with retching (sometimes). Three days previosuly, the skin and sclera stained yellow, and the urine colour had become darker. On hospitalisation, he showed abnormal liver biochemical indexes, with total bilirubin, direct bilirubin, indirect bilirubin, ALT, AST , alkaline phosphatase, γ-glutamyl transferase, bile acid, albumin, globulin and albumin and globulin ratio of 138.5 µmol/L, 68.58 µmol/L, 69.92 µmol/L, 1279 U/L, 856 U/L, 608 U/L, 362 U/L, 319.5 µmol/L, 39.1 g/L, 43.2 g/L and 0.9, respectively. Monocytes were 10.8%. He was admitted for pending investigations of causes of jaundice. On anamnesis, he was noted to have serum ALT of up to 58 U/L and a history of intermittent urticaria for >3 years. The symptoms had resolved 3 weeks after infusion of cefoperazone/sulbactam [cefoperazone/sulbactam sodium] injection and levofloxacin injection for about 21 days [not all routes stated; dosages not stated] , which were administered 2 months previously, for pulmonary infection. Physical examination showed severe yellow staining of the skin and sclera, coarse breath sounds in both the lungs, flat abdomen along with rebound tenderness and muscle tension in the whole abdomen. Chest X-ray and CT scan showed bronchitis in both the lungs with surrounding exudative changes and multiple large lymph nodes in the mediastinum. Initial diagnoses of liver injury and lung infection were made. However, RUCAM score was between 1–2 points after admission; hence, diagnosis of DILI was not considered. He received symptomatic treatments, and underwent multiple tests. Autoimmune liver disease test showed positive anti-mitochondrial antibody-M2. Immune function combination test showed immunoglobulin G level of 29.8 g/L, and Epstein-Barr virus (EBV)-CA immunoglobulin G was found to be positive. Additionally, he still had abnormal liver biochemical indexes. Subsequently, a presumed diagnosis of autoimmune liver disease (primary biliary cholangitis and autoimmune hepatitis overlap syndrome) was made, in addition to lung infection. Therefore, the man started receiving treatment with ursodeoxycholic acid, and after 1 week, he showed improved results of liver biochemical indexes. However, on hospitalisation day 10, he developed fever, shortness of breath and dizziness. Physical examination showed enlargement of the bilateral supraclavicular lymph nodes, which were in different sizes and had smooth surfaces with tenderness. Subsequent blood test showed pos