Flucloxacillin-Induced Hepatotoxicity - Association with HLA-B*5701

Revista da Associação Médica Brasileira
Mónica TeixeiraLuís Costa Matos

Abstract

Drug-induced liver injury (DILI) to flucloxacillin is rare and is classified as idiosyncratic, as it is dependent on individual susceptibility, unpredictable, and dose-independent. The authors present the case of a 74 - year - old man with a history of monoclonal gammopathy under investigation and alcoholic habits of 24 g/day, with asthenia, anorexia, nausea, abdominal discomfort, and fever with three days of evolution. He was treated with two courses of antibiotic therapy with flucloxacillin to erysipelas previously (3 months and 2 weeks before admission). Lab tests showed serum AST levels of 349 U/L, ALT 646 U/L, alkaline phosphatase 302 U/L, GGT 652 U/L, total bilirubin 3.3 mg/dL and direct bilirubin 2.72 mg/dL. Infectious, autoimmune, and metabolic causes were ruled out. Magnetic resonance cholangiopancreatography showed normal results. Liver biopsy showed mild multifocal (predominantly microvesicular) steatosis; marked changes in the centrilobular areas (sinusoidal dilatation, marked congestion, hemorrhage, and multifocal hepatocyte collapse); expansion of the portal areas with the formation of bridges; proliferated bile ducts and inflammatory infiltrate of variable density, predominantly mononuclear type. The HLA-B*5701 s...Continue Reading

References

Jun 2, 2009·Nature Genetics·Ann K DalyUNKNOWN International SAE Consortium
Apr 17, 2010·Gastroenterology·Naga Chalasani, Einar Björnsson
Sep 17, 2013·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·David E KleinerUNKNOWN Drug-Induced Liver Injury Network (DILIN)
Jun 18, 2014·The American Journal of Gastroenterology·Naga P ChalasaniUNKNOWN Practice Parameters Committee of the American College of Gastroenterology
Nov 16, 2016·Clinics in Liver Disease·Humberto C GonzalezStuart C Gordon
Nov 16, 2016·Clinics in Liver Disease·Zachary D Goodman
Mar 31, 2019·Journal of Hepatology·UNKNOWN European Association for the Study of the Liver. Electronic address: easloffice@easloffice.euUNKNOWN EASL Governing Board representative:

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Citations

Sep 18, 2021·Drug Safety : an International Journal of Medical Toxicology and Drug Experience·Joseph William ClintonJames H Lewis

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