Possible Levofloxacin‐Induced Acute Hepatocellular Injury in a Patient with Chronic Obstructive Lung Disease

Abstract

Levofloxacin is one of the most commonly prescribed antibiotics for both inpatient and outpatient care of respiratory tract infection. It is generally well tolerated, and it has an excellent safety profile. We report a case of severe acute liver toxicity that apparently complicated intravenous administration of levofloxacin, which resolved after discontinuation of the drug.

Efficacy and safety of levofloxacin in the context of other contemporary fluoroquinolones: a review

“…55,56,88,89 Reports of significant levofloxacin-associated hepatotoxicity are extremely rare. 90 More severe adverse effects (AEs) were reported with trovafloxacin (a fluoronaphthyridone) during PMS, with treatment leading to liver failure, 91 the necessity for transplantation, 91 and a small number of deaths 91 ; these AEs may have been related to a hypersensitivity reaction and perhaps associated with neoantigen formation induced by the 1-[2,4]-difluorophenyl side chain. 55,92 These findings led to the suspension/withdrawal of trovafloxacin in June 1999.…”

Severe Ductopenia and Cholestasis from Levofloxacin Drug-Induced Liver Injury: A Case Report and Review

“…Within 2 days of drug initiation, she was found to have significant elevation of transaminases consistent with hepatocellular DILI, which resolved after discontinuation of levofloxacin. 19 In 2001, the first reported case of fatal levofloxacin-associated acute liver failure was also reported. A 99-year-old man progressed to acute fatal liver failure after exposure to levofloxacin 500 mg daily for treatment of a urinary tract infection.…”

Hepatitis colestásica aguda asociada a levofloxacino

“…Todos los derechos reservados. tocelular por trovaflocaxino, lesión hepatocelular ictérica y anictérica con ofloxacino y norfloxacino, respectivamente, lesión colestásica por ciprofloxacino y ofloxacino, hepatitis granulomatosa por flumequina y hepatitis fulminante por ciprofloxacino 7,10 . Respecto a levofloxacino, tras hacer una revisión en Medline entre 1998 y 2010, se han encontrado 7 casos de hepatotoxicidad: cuatro casos atribuibles a levofloxacino 7,10-12 , y tres tras tratamiento secuencial asociado con diferentes antibióticos [13][14][15] .…”

“…El periodo de latencia fue variable, desde 2 días 10 hasta 30 días 15 , desarrollándose en un caso al quinto día 13 como en nuestro caso. En 4 casos el desenlace fue fatal: dos de ellos 12,14 por fallo fulminante a los 14 y 27 días, respectivamente, en otro por coma hepático a los 6 días de la suspensión de levofloxacino 11 y el último por complicación de la neumonía y fallo multiorgánico 10 . Los otros 3 casos 7,13,15 tuvieron una resolución favorable, con normalización variable de las pruebas hepáticas según el caso (7, 70 y 103 días, respectivamente).…”