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The article investigates the case of a 20-month old female who was treated for Wilms tumor stage I. The patient underwent left nephrectomy and chemotherapy according to national chemotherapy protocol of Wilms tumor in children and subsequently given acetaminophen for an ulcerative lesion on the forearm. After 29 days of acetaminophen treatment, the patient suffered acute liver failure (ALF) and lapsed to comatose status upon admission to the pediatric intensive care unit (PICU). After spontaneous recovery, it was concluded that prolonged use of acetaminophen combined with other liver-metabolized drugs can lead to potential risk of ALF.