Liver injury related to amoxycillin-clavulanic acid: interlobular bile-duct lesions and extrahepatic manifestations

Hautekèete, M.; Brenard, R.; Horsmans, Yves; Henrion, Jean; Verbist, Louis; Derue, G.; Druez, Patrick; Omar, Mohamed A.; Kockx, M.; Hubens, H; Haber, I; Rahier, Jacques; Geubel, André

doi:10.1016/0168-8278(95)80262-2

Cited by 87 publications

(25 citation statements)

References 28 publications

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“…The degree of bile duct injury may correlate with serum levels of alkaline phosphatase but there is usually no correlation with histologic cholestasis or the duration of jaundice. 75,76 Rare cases of bile duct loss and granulomatous hepatitis have been reported after exposure to amoxicillin-clavulanate. 71,74,77 Most patients recover within 4 to 6 months following DILI due to amoxicillin-clavulanate.…”

Section: Some Select Agents That Cause Dilimentioning

confidence: 99%

“…71,74,77 Most patients recover within 4 to 6 months following DILI due to amoxicillin-clavulanate. 66,71,76 Rare patients may progress to ductopenia or to acute liver failure and death 77,78 ; severe outcomes were reported in 2.9% of cases in one series. 20 Because amoxicillin-clavulanate hepatotoxicity may cause decompensation of cirrhosis, it should be administered with caution in cirrhotic patients, especially those who are elderly or have had previous exposure to the drug.…”

Section: Some Select Agents That Cause Dilimentioning

confidence: 99%

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Drug-Induced Liver Injury

Fisher¹,

Vuppalanchi²,

Saxena

2015

Archives of Pathology &Amp; Laboratory Medicine

163

116

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Context Drug-induced liver injury (DILI) represents a diverse set of responses following exposure to any manufactured or naturally occurring chemical compound. Drug-induced liver injury is of major concern owing to the ever increasing number of compounds introduced into the market for treatment of various diseases as well as the increasing popularity of herbals, which lend themselves to self-medication but are not rigorously regulated. Objective To provide an overview of the prevalence, classification, and diagnosis of DILI with emphasis on pathogenesis and the role of a liver biopsy. To focus on the most common, emerging, and herbal agents that cause DILI with emphasis on the histologic pattern of injury observed. Data Sources A review of the literature was drawn from the PubMed (US National Library of Medicine) repository, textbooks, and online databases. All figures were taken from cases seen at our tertiary referral center, which is 1 of 12 participating sites in the National Institutes of Health–funded Drug-Induced Liver Injury Network. Conclusions Drug-induced liver injury due to prescription, over-the-counter, and herbal products is a major cause of liver disease in the United States and around the world. Diagnosis of DILI is challenging because there is no single clinical, laboratory, or histologic feature specific to DILI. Accurate diagnosis requires establishing a causal relationship with the suspected agent and excluding competing causes of liver injury. The liver biopsy is an essential component in the management of DILI by offering clues to the underlying pathogenesis, providing prognostic information, and guiding therapy.

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Section: Some Select Agents That Cause Dilimentioning

confidence: 99%

Section: Some Select Agents That Cause Dilimentioning

confidence: 99%

Drug-Induced Liver Injury

Fisher¹,

Vuppalanchi²,

Saxena

2015

Archives of Pathology &Amp; Laboratory Medicine

163

116

View full text Add to dashboard Cite

show abstract

“…In our patient, early fibrosis at 5 mo after exposure to amoxicillin/clavulanate may explain the prolonged cholestasis and immunosuppressant dependency. Patients reported complete recovery from prolonged amoxicillin/clavulanate-induced cholestasis did not have fibrosis on liver biopsy [2,[11][12][13][14] . By contrast, in Degott's review of drug-induced cholestasis, all patients with persistent cholestasis had moderate to severe fibrosis [15] .…”

Section: Discussionmentioning

confidence: 99%

“…These include advanced age, male sex, a cholestatic pattern of liver injury, delay between cessation of therapy and onset of jaundice, repeatedly negative tests for viral, autoimmune and metabolic diseases, and negative imaging studies [2,[11][12][13][14] . Primary biliary cirrhosis and autoimmune cholangiopathy were considered unlikely, given the patient's age, gender, repeatedly negative serology, and histopathology.…”

Section: Discussionmentioning

confidence: 99%

Mycophenolate mofetil for drug-induced vanishing bile duct syndrome

Jakab¹

2007

WJG

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Amoxicillin/clavulanate is associated with liver injury, mostly of a cholestatic pattern. While outcomes are usually benign, progression to cirrhosis and death has been reported. The role of immunosuppressive therapy for patients with a protracted course is unclear. We report the case of an elderly patient who developed prolonged cholestasis secondary to amoxicillin/clavulanate. Vanishing bile duct syndrome was confirmed by sequential liver biopsies. The patient responded to prednisone treatment, but could not be weaned off corticosteroids, even when azathioprine was added. Complete withdrawal of both prednisone and azathioprine was possible by using mycophenolate mofetil, an inosine monophosphate dehydrogenase inhibitor. Sustained remission has been maintained for more than 3 years with low-dose mycophenolate mofetil.

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“…Our case had the typical characteristics of amoxicillin/ clavulanate-induced liver injury. These include advanced age, male sex, a cholestatic pattern of liver injury, delay between cessation of therapy and onset of jaundice, repeatedly negative tests for viral, autoimmune and metabolic diseases, and negative imaging studies [2,[11][12][13][14] . Primary biliary cirrhosis and autoimmune cholangiopathy were considered unlikely, given the patient's age, gender, repeatedly negative serology, and histopathology.…”

Section: Discussionmentioning

confidence: 99%