Metronidazole Induced Liver Injury : A Rare Immune Mediated Drug Reaction
Joint Authors
Vipperla, Kishore
Gajendran, Mahesh
Kancherla, Dayakar
Vallabhaneni, Priyanka
Source
Case Reports in Emergency Medicine
Issue
Vol. 2013, Issue 2013 (31 Dec. 2013), pp.1-4, 4 p.
Publisher
Hindawi Publishing Corporation
Publication Date
2013-12-23
Country of Publication
Egypt
No. of Pages
4
Main Subjects
Abstract EN
Drug induced liver injury (DILI) can result either from dose-dependent direct hepatotoxicity or from an unpredictable dose-independent idiosyncratic reaction.
Incidence of idiosyncratic DILI is estimated to be approximately 10–15 per 100,000 patient years.
Here we report an extremely rare case of metronidazole induced delayed immune-allergic hepatocellular liver injury masquerading as autoimmune hepatitis.
A previously healthy 54-year-old Caucasian male, who was treated with metronidazole for Clostridium difficile associated diarrhea, presented 3 months later with right upper quadrant abdominal pain.
Laboratory tests revealed total bilirubin level of 12.7 mg/dL, direct bilirubin of 7.2 mg/dL, alanine aminotransferase (ALT) of 973 IU/L, aspartate transaminase (AST) of 867 IU/L, alkaline phosphatase (AP) of 96 IU/L, and an INR of 1.9, suggestive of hepatocellular pattern of injury.
A detailed workup for hepatitis revealed no other etiology.
A clinical diagnosis of metronidazole induced liver injury was made.
With a persistent rise in his bilirubin and transaminase levels, the patient was started on oral prednisone.
At the 2-week posthospitalization follow-up visit, the patient reported a significant improvement in his overall sense of being well and liver functions tests trended down substantially (total bilirubin 7.2 mg/dL, ALT 420 IU/L, AST 276 IU/L, AP 183 IU/L, and INR 1.5).
American Psychological Association (APA)
Kancherla, Dayakar& Gajendran, Mahesh& Vallabhaneni, Priyanka& Vipperla, Kishore. 2013. Metronidazole Induced Liver Injury : A Rare Immune Mediated Drug Reaction. Case Reports in Emergency Medicine،Vol. 2013, no. 2013, pp.1-4.
https://search.emarefa.net/detail/BIM-481377
Modern Language Association (MLA)
Kancherla, Dayakar…[et al.]. Metronidazole Induced Liver Injury : A Rare Immune Mediated Drug Reaction. Case Reports in Emergency Medicine No. 2013 (2013), pp.1-4.
https://search.emarefa.net/detail/BIM-481377
American Medical Association (AMA)
Kancherla, Dayakar& Gajendran, Mahesh& Vallabhaneni, Priyanka& Vipperla, Kishore. Metronidazole Induced Liver Injury : A Rare Immune Mediated Drug Reaction. Case Reports in Emergency Medicine. 2013. Vol. 2013, no. 2013, pp.1-4.
https://search.emarefa.net/detail/BIM-481377
Data Type
Journal Articles
Language
English
Notes
Includes bibliographical references
Record ID
BIM-481377