Idiosyncratic Drug-Induced Liver Injury Due to Ciprofloxacin: A Report of Two Cases and Review of the Literature

Abstract

Case seriesPatient: Male, 35 • Male, 82Final Diagnosis: Idiosyncratic DILI due to CiprofloxacinSymptoms: Abdominal discomfort • fever • jaundice • nauseaMedication: CiprofloxacinClinical Procedure: —Specialty: Gastroenterology and HepatologyObjective:Challenging differential diagnosisBackground:Drug-induced liver injury (DILI) can present clinically as a spectrum that includes asymptomatic elevation of transaminases, acute or chronic hepatitis, and acute liver failure. Idiosyncratic DILI is more likely to affect individuals with comorbidities, and to have a wide range of clinical presentations. Although antibiotics are associated with DILI, the fluoroquinolone, ciprofloxacin, is a rarely reported cause. Two cases of idiosyncratic DILI following ciprofloxacin treatment are described, including a review of the literature.Case Report:Case 1: A 35-year-old man was treated with ciprofloxacin for periorbital cellulitis. On the second day of ciprofloxacin treatment, he developed abdominal pain, nausea, vomiting and increased serum levels of liver transaminases, aspartate aminotransferase (AST), and alanine aminotransferase (ALT). Further investigations excluded infectious hepatitis, autoimmune disease, or structural liver disease. Exclusion of other causes of DILI and cessation of ciprofloxacin resulted in clinical improvement and normalization of liver function tests (LFTs). Case 2: An 82-year-old man was treated with ciprofloxacin for osteomyelitis. On the tenth day of ciprofloxacin treatment, he developed jaundice and abnormal LFTs, including increased AST, ALT, alkaline phosphatase (ALP), and total bilirubin. Further investigations excluded infectious hepatitis, autoimmune disease, or structural liver disease. Exclusion of other causes of DILI and cessation of ciprofloxacin resulted in clinical improvement and normalization of LFTs.Conclusions:Idiosyncratic DILI due to ciprofloxacin treatment is rare. These two cases have shown that timely diagnosis and discontinuation of ciprofloxacin can prevent the progression of DILI, reduce liver damage, and reduce mortality rates from DILI.

Organophosphorus Pesticide Malathion and Immunotoxicity: A More Sensitive Toxicological Target and Current Recommendations

“…In the meantime, hepatocyte necrosis in a small lesion with a little of inflammatory cell infiltration in the middle-dose group, as well as edema of hepatocytes in the high-dose group were observed. Similar results had been reported in 2 cases of drug-induced hepatic injury (DILI) (28) and some hepatotoxicity studies of MLT, including histopathological and hematological changes (29)(30)(31). In addition to that, the absolute and relative weights of liver in the high-dose group were increased, which might be induced by the metabolism of MLT.…”

Antibacterial antibiotic-induced drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome: a literature review

“…Alkhateeb et al presented a case of ciprofloxacin-induced DRESS syndrome with a beginning of symptoms only 2 days after drug exposure [ 48 ]. It is interesting to note that the same finding is observed in idiosyncratic ciprofloxacin-induced liver injury [ 49 ]. However, based on this review, the mean latency period was 7.7 d. Moreover, it seems that FQ-induced DRESS is mild and eventually is controlled a few days after drug discontinuation in many cases without any other intervention.…”

Clinical Characteristics of 162 Patients with Drug-Induced Liver and/or Kidney Injury

“…ere are more than 1,000 drugs known to cause liver injury. e pathogenesis of drug-induced liver injury can be summarized as follows [12]: (1) direct toxicity of the drug or metabolite for the liver or (2) a specific heterogeneous response [13]: mediated by the immune response or the metabolic response, including oxidative stress, mitochondrial damage [14], and the adaptive immune response.…”