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

Abstract

A 67-year-old woman with hypertension, hypothyroidism, and glaucoma was referred for jaundice and elevated liver function tests. She was treated for streptococcal endophthalmitis with 2 weeks of intravenous (IV) levofloxacin followed by 2 months of oral levofloxacin. The patient had no prior history of liver disease and denied alcohol intake. Her physical exam was remarkable for jaundice and scleral icterus without any stigmata of liver disease. Viral hepatitis serologies and antibodies, including myeloperoxidase, proteinase 3, and antinuclear, antimitochondrial, antiliver kidney microsome, antismooth muscle antibodies, were all within normal limits. The liver biopsy revealed severe cholestasis, extensive bile duct loss, and fibrosis. The patient had no known exposure to any other systemic medications or inciting factors other than levofloxacin. Although there are a few reported cases of drug-induced liver disease (DILI) related to levofloxacin, this case is believed to be the first reported case of ductopenia or vanishing bile duct syndrome (VBDS) associated with levofloxacin. Although fluoroquinolones, such as levofloxacin, are generally considered safe antibiotics, health practitioners must be aware of their association with DILI, as the diagnosis of DILI is one of exclusion and requires a high index of suspicion.

<p>Incidence, clinical features, and risk factors of fluoroquinolone-induced acute liver injury: a case-control study</p>

“…The same year, the China Food and Drug Administration also warned of liver injury related to moxifloxacin use. One of the most frequently prescribed fluoroquinolones, levofloxacin, also carries a risk of inducing liver injury, and its hepatotoxicity has already been reported many times 9,10. Thus, it is important for health care providers to be aware of the association of fluoroquinolones with hepatotoxicity.…”

Polyene Phosphatidyl Choline Injection Regulates Lipid Homeostasis via AKT-PDE3-PKA in Mice

“…When combined with hepatotoxic drugs such as levo oxacin [17] and ornidazole [18] we found no signi cant impact on the patient's liver damage indicators and lipid metabolism, indicating that PPC injection can counteract the liver-damaging effects of hepatotoxic drugs.…”

Hepatotoxicity of Antibiotics and Antifungals and Their Safe Use in Hepatic Impairment

“…10 However, cases of ALF leading to death have also been reported. [122][123][124] Instances of cholestasis with ductopenia have been reported as well, [125][126][127] with one case leading to liver transplantation. 118 Prescribing guidance varies between the FDA and EMA.…”