Severe Lenalidomide-Associated Hyperbilirubinemia. 

 -  2023 
<br/><br/> Immunomodulatory drugs (IMids), such as thalidomide and lenalidomide, are used to treat plasma cell neoplasms and B-cell malignancies. We present a case of severe direct hyperbilirubinemia in a patient taking lenalidomide-based therapy for plasmacytoma. Imaging was unrevealing, and liver biopsy showed only mild sinusoidal dilation. Roussel Uclaf Causality Assessment (RUCAM) score was 6, indicating lenalidomide was a probable cause of the injury. To our knowledge, this is the highest reported direct bilirubin regarding lenalidomide drug-induced liver injury (DILI), with a peak bilirubin of 41mg/dL. While a clear pathophysiology was not identified, this case provides important considerations regarding lenalidomide safety. Copyright © 2023, Gildea et al. 
<br/><br/><br/>English 
<br/><br/><label>ISSN: </label>2168-8184 
<br/><br/><label>Standard No.: </label>10.7759/cureus.34408 [doi] PMC9977541 [pmc] 
<br/><br/><label>Index Terms--Occupation: </label><br/>Internal Medicine Residency<br/>MedStar Georgetown University Hospital/MedStar Washington Hospital Center
<br/><br/><label>Index Terms--Function: </label><br/>Case Reports