Purpose: A report of acute azithromycin-induced hepatocellular injury is described. Summary: An 83-year-old male was admitted with possible community-acquired pneumonia and received azithromycin and ceftriaxone. After 2 doses of azithromycin, the patient’s aspartate aminotransferase and alanine aminotransferase were greater than 3 times the upper limit of normal and continued to rise with subsequent doses. A diagnostic abdominal ultrasound revealed hepatomegaly. Total bilirubin remained within normal limits during the course. Rosuvastatin and fenofibrate were held on admission and were not resumed in the setting of elevated liver enzymes. Rivaroxaban was held in the setting of worsening renal function. Hepatitis serologies were negative. Liver enzymes, international normalized ratio (INR), and activated partial thromboplastin time (aPTT) continued to climb until hospital day 5 when azithromycin was discontinued in response. Liver enzymes, INR, aPTT, and lactate dehydrogenase all decreased from hospital days 6 through 8. Conclusion: A potentially serious liver injury occurred with the initiation of azithromycin and began to resolve quickly after its discontinuation. While cholestatic injury with azithromycin is well described, this is only the third reported case of direct hepatocellular injury.

difference in complication rates between the groups (p = 0.465) and there was no peri-operative mortality. Hospital stay was shorter in the PVE group (7.84 VS 8.95 d, p = 0.038). 5-year overall survival rate and disease free survival rate were similar between groups (53.2% VS 54.4%; p = 0.999 and 38.3% VS 40.6%; p = 0.823) Median overall survival and disease free survival were 65.4 months and 33.6 months respectively, with a median overall follow-up of 39.3 months. Conclusion:Our results showed similar survival whether PVE was used or not. Hence, PVE offers a chance for cure for patients who could not be operated upfront. Moreover, PVE patients seem to have the same prognosis even with a larger extent of disease.

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