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Although vancomycin has been linked to hepatic injury in case reports, evidence for its role in causing severe multisystem toxicity remains limited ( Tislelizumab, a PD-1 inhibitor, carries a recognized risk of immune-related hepatitis (irH) ( The patient reported chronic heavy alcohol intake (~200 g/day), which is recognized as a susceptibility factor in RUCAM and was incorporated into the risk-factor domain together with age 55 years (maximum contribution)

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