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Ciprofloxacin Exposure Leading to Fatal Hepatotoxicity: An Unusual Correlation

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ABSTRACT

Patient: female, 74"/>

Lab values on the days of admission and discharge, days 1 and 14 respectively, from inpatient stay 2.
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f2-amjcaserep-17-676: Lab values on the days of admission and discharge, days 1 and 14 respectively, from inpatient stay 2.

Mentions: Over the course of six days, the patient developed progressive weakness and new-onset vomiting and jaundice, and was subsequently admitted. Her physical examination was remarkable for bilateral pedal edema and icterus. Significant labs on admission included: AST 1,263, ALT 870, ALP 496, TBIL 8.9, albumin 2.5, international normalized ratio (INR) 1.2, and platelets 185,000 (Figure 2). Acetaminophen and salicylate levels were obtained, as these drugs are frequent offenders of hepatotoxicity, but were within normal limits. At this time, the patient was taken off of simvastatin as it is a relatively common offender of hepatotoxicity. She also received an extensive workup for liver disease. Serologies for viral hepatitis including antibody screening for hepatitis A, B, C, D and E were all nonreactive. Similarly, serologies for herpes simplex virus (HSV) and cytomegalovirus (CMV) were not suggestive of a cause. Imaging studies including abdominal CT and abdominal ultrasound showed nonspecific heterogeneity of the liver. Similarly, magnetic resonance cholangiopancreatography (MRCP) revealed an atrophic right hepatic lobe. The patient underwent a liver biopsy, which was essentially inconclusive, showing active chronic hepatitis with cholestasis and portal and periportal fibrosis. Additional studies including alpha 1 antitrypsin, ceruloplasmin, antinuclear antibodies (ANA), anti-mitochondrial antibodies (AMA), and IgG were of no benefit. CA 19-9 was increased at 187; however, CT and MRCP showed no mass. Additionally, alpha-fetoprotein (AFP) and carcinoembryonic antigen (CEA) were within normal limits. Furthermore, hematology-oncology was consulted and concluded no further workup for malignancy was necessary. Following mild decreases in liver enzymes, despite a rise in bilirubin, the patient was discharged and instructed to follow up with her gastroenterologist.


Ciprofloxacin Exposure Leading to Fatal Hepatotoxicity: An Unusual Correlation
Lab values on the days of admission and discharge, days 1 and 14 respectively, from inpatient stay 2.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC5036381&req=5

f2-amjcaserep-17-676: Lab values on the days of admission and discharge, days 1 and 14 respectively, from inpatient stay 2.
Mentions: Over the course of six days, the patient developed progressive weakness and new-onset vomiting and jaundice, and was subsequently admitted. Her physical examination was remarkable for bilateral pedal edema and icterus. Significant labs on admission included: AST 1,263, ALT 870, ALP 496, TBIL 8.9, albumin 2.5, international normalized ratio (INR) 1.2, and platelets 185,000 (Figure 2). Acetaminophen and salicylate levels were obtained, as these drugs are frequent offenders of hepatotoxicity, but were within normal limits. At this time, the patient was taken off of simvastatin as it is a relatively common offender of hepatotoxicity. She also received an extensive workup for liver disease. Serologies for viral hepatitis including antibody screening for hepatitis A, B, C, D and E were all nonreactive. Similarly, serologies for herpes simplex virus (HSV) and cytomegalovirus (CMV) were not suggestive of a cause. Imaging studies including abdominal CT and abdominal ultrasound showed nonspecific heterogeneity of the liver. Similarly, magnetic resonance cholangiopancreatography (MRCP) revealed an atrophic right hepatic lobe. The patient underwent a liver biopsy, which was essentially inconclusive, showing active chronic hepatitis with cholestasis and portal and periportal fibrosis. Additional studies including alpha 1 antitrypsin, ceruloplasmin, antinuclear antibodies (ANA), anti-mitochondrial antibodies (AMA), and IgG were of no benefit. CA 19-9 was increased at 187; however, CT and MRCP showed no mass. Additionally, alpha-fetoprotein (AFP) and carcinoembryonic antigen (CEA) were within normal limits. Furthermore, hematology-oncology was consulted and concluded no further workup for malignancy was necessary. Following mild decreases in liver enzymes, despite a rise in bilirubin, the patient was discharged and instructed to follow up with her gastroenterologist.

View Article: PubMed Central - PubMed

ABSTRACT

Patient: female, 74"/>