Dimethyl Fumarate-Associated Acute Hepatocellular Injury Assessed for Causality Using the Updated RUCAM: A Biopsy-Supported Case Report.

Dimethyl fumarate may rarely cause severe hepatocellular injury. In a 26-year-old woman, liver enzymes rose soon after treatment initiation, and biopsy supported DILI. Updated RUCAM assessment yielded 6, indicating probable causality, supported by dechallenge. Negative ANA reduced autoimmune hepatitis likelihood, although untested hepatitis E limited alternative-cause assessment and causal certainty.