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Levorato AD, Moris DV, Cavalcante RDS, Sylvestre TF, de Azevedo PZ, de Carvalho LR, Mendes RP. Evaluation of the hepatobiliary system in patients with paracoccidioidomycosis treated with cotrimoxazole or itraconazole. Med Mycol 2017; 56:531-540. [DOI: 10.1093/mmy/myx080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 08/24/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Adriele Dandara Levorato
- Tropical Diseases Department, São Paulo State University (UNESP), Faculdade de Medicina de Botucatu, Campus Botucatu, Brazil
| | | | - Ricardo de Souza Cavalcante
- Tropical Diseases Department, São Paulo State University (UNESP), Faculdade de Medicina de Botucatu, Campus Botucatu, Brazil
| | - Tatiane Fernanda Sylvestre
- Tropical Diseases Department, São Paulo State University (UNESP), Faculdade de Medicina de Botucatu, Campus Botucatu, Brazil
| | - Priscila Zacarias de Azevedo
- Tropical Diseases Department, São Paulo State University (UNESP), Faculdade de Medicina de Botucatu, Campus Botucatu, Brazil
| | | | - Rinaldo Poncio Mendes
- Tropical Diseases Department, São Paulo State University (UNESP), Faculdade de Medicina de Botucatu, Campus Botucatu, Brazil
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Stine JG, Lewis JH. Hepatotoxicity of antibiotics: a review and update for the clinician. Clin Liver Dis 2013; 17:609-42, ix. [PMID: 24099021 DOI: 10.1016/j.cld.2013.07.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Collectively, the various classes of antibiotics are a leading cause of drug-induced liver injury (DILI). However, acute antibiotic-associated DILI can be difficult to diagnose, as the course of therapy is usually brief, and other confounding factors are often present. In addition to the broad clinicopathologic spectrum of hepatotoxicity associated with the antimicrobials, the underlying infectious disease being treated may itself be associated with hepatic dysfunction and jaundice. This review provides summarized information on several classes of antimicrobial agents, highlighting new agents causing DILI and updating information on older agents.
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Affiliation(s)
- Jonathan G Stine
- Division of Gastroenterology and Hepatology, Department of Medicine, Georgetown University Medical Center, 3800 Reservoir Road, NW Room M2408, Washington, DC 20007, USA
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Ilario MJ, Ruiz JE, Axiotis CA. Acute fulminant hepatic failure in a woman treated with phenytoin and trimethoprim-sulfamethoxazole. Arch Pathol Lab Med 2000; 124:1800-3. [PMID: 11100060 DOI: 10.5858/2000-124-1800-afhfia] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Massive hepatic necrosis following exposure to phenytoin and trimethoprim-sulfamethoxazole is a rare occurrence and to the best of our knowledge has not been reported previously. Acute hepatic failure following administration of trimethoprim-sulfamethoxazole has rarely been seen, and only 4 cases have been well documented pathologically. We report a case of acute liver failure in a 60-year-old woman following ingestion of phenytoin and trimethoprim-sulfamethoxazole concomitantly over a 9-day period. Autopsy findings revealed acute fulminant hepatic failure. This case demonstrates the effects of chemical-chemical interactions in the potentiation of hepatotoxicity of single agents and specifically illustrates the need for discontinuing trimethoprim-sulfamethoxazole in the presence of early liver injury.
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Affiliation(s)
- M J Ilario
- Department of Pathology, State University of New York Health Science Center at Brooklyn, 11203, USA
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Abstract
A 34-yr-old woman developed simultaneous pancreatitis and hepatitis following exposure to trimethoprim-sulfamethoxazole (TMP/SMX). The episode occurred 4 yr after a previous episode of hepatitis associated with TMP/SMX. This patient represents the second case of concurrent TMP/SMX-induced pancreatitis and hepatitis reported in the literature. However, it is the first in which the adverse reaction was documented following an inadvertent rechallenge with the drug.
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Affiliation(s)
- A S Brett
- Department of Medicine, University of South Carolina School of Medicine, Richland Memorial Hospital, Columbia, USA
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Twedt DC, Diehl KJ, Lappin MR, Getzy DM. Association of hepatic necrosis with trimethoprim sulfonamide administration in 4 dogs. J Vet Intern Med 1997; 11:20-3. [PMID: 9132479 DOI: 10.1111/j.1939-1676.1997.tb00068.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Hepatic necrosis in association with trimethoprim-sulfonamide (TMS) combination therapy was diagnosed in 4 dogs based on history, clinical presentation, and examination of histopathologic specimens collected postmortem. Duration of TMS therapy prior to onset of clinical signs ranged from 4 to 30 days. The dose of TMS ranged from 18 mg/kg to 53 mg/kg bid. Despite supportive medical therapy, all dogs died or were euthanized due to hepatic failure. This report highlights the potential for hepatotoxicity during TMS therapy. Duration of therapy, type of TMS combination, and dose did not appear related to the development of toxicity. The low number of dogs affected suggests an idiosyncratic drug reaction.
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Affiliation(s)
- D C Twedt
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, USA
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Abstract
Hepatotoxic reactions to antibacterials are rare, occurring with an estimated frequency of between 1 and 10 per 100,000 drug prescriptions for most antibacterials. Although many antibacterial-induced hepatotoxic reactions have a characteristic clinical and biochemical pattern e.g. cholestatic hepatitis (flucloxacillin) or fatty liver (tetracycline), many can also present with a variety of clinicopathological patterns e.g. nitrofurantoin is associated with the development of acute hepatitis, granulomatous hepatitis and chronic active hepatitis. Almost all reactions are idiosyncratic, with no diagnostic laboratory tests to aid the diagnosis. Early diagnosis is essential and requires a vigilant physician to elicit a detailed drug history. Although the outcome is usually good when the offending antibacterial is withdrawn, morbidity may persist for years and fatalities have occurred, particularly when there is a delay in recognising the hepatotoxic antibacterial. There is no specific treatment for antibacterial-induced hepatotoxicity other than withdrawing the implicated drug. For severe disease, however, liver transplantation should be considered.
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Affiliation(s)
- D K George
- Joint Liver Programme, University of Queensland, Australia
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Bussières JF, Habra M. Application of International Consensus Meeting Criteria for classifying drug-induced liver disorders. Ann Pharmacother 1995; 29:875-8. [PMID: 8547737 DOI: 10.1177/106002809502900910] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To report a patient with 2 consecutive reversible drug-induced liver disorders and the application of International Consensus Meeting Criteria for the screening and diagnosis of drug-induced liver disorders. CASE SUMMARY An 88-year-old man in a chronic care institution developed abdominal discomfort and jaundice after finishing a 10-day course of trimethoprim/sulfamethoxazole therapy for a urinary tract infection (UTI). The jaundice and the symptoms resolved spontaneously and the final diagnosis was symptomatic drug-induced liver injury, mixed type. After 1 month, the same patient received a course of cefadroxil therapy for another UTI. He developed an asymptomatic drug-induced liver injury, mixed type. Six months later, the patient received oral penicillin therapy and then ciprofloxacin, with no change in his liver function test results. DISCUSSION To our knowledge, there are only a few other reports in the literature of a drug-induced liver injury with cefadroxil therapy; more cases are reported with trimethoprim/sulfamethoxazole than with cefadroxil. The criteria of an International Consensus Meeting were helpful to evaluate both incidences of liver injury in this patient with the aim of establishing the diagnosis and causality assessment. Additionally, the criteria were used to show that the patient had 2 separate liver injuries. CONCLUSIONS Screening and diagnosis of drug-induced liver disorders depend on careful history taking and 5 specific biochemical liver tests. The evolution of the liver disorder induced by cefadroxil therapy probably was interrupted because of its early detection. Appropriate screening was done with the subsequent administration of new potentially hepatotoxic drugs.
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Baciewicz AM, Hapke RJ, Todd CY. Cholestasis: hepatocellular reaction to trimethoprim/sulfamethoxazole. Ann Pharmacother 1994; 28:1310-1. [PMID: 7849362 DOI: 10.1177/106002809402801130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Abstract
OBJECTIVE To study whether there are adverse liver reactions to trimethoprim and, if found, to describe the biochemical pattern of these reactions. DESIGN We surveyed all liver reactions from trimethoprim to SADRAC (Swedish Adverse Drug Reactions Advisory Committee) from 1980 to 1989. MAIN OUTCOME MEASURE Incidence of reported adverse liver reactions [number of reported adverse liver reactions/sales of trimethoprim in defined daily dose (DDD)]. RESULTS During 1980-1989, 21 suspected liver reactions from trimethoprim were reported. A causal relationship was considered probable in 10 of these reports, which gives an incidence of 1/1360000 DDD. The distribution of reaction types for trimethoprim was virtually identical to that found in corresponding adverse reports for trimethoprim-sulfonamides, whereas the sulfonamides as single drugs displayed a significantly higher proportion of more severe hepatocellular reactions.
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Affiliation(s)
- A Lindgren
- Department of Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
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Abstract
Drug-induced liver injury due to trimethoprim sulfamethoxazole is rare and classified as an unpredictable or idiosyncratic type of hepatotoxic reaction. Early reports suggested that the pattern of liver injury in the majority of cases is mixed hepatocellular-cholestatic. The current report describes two cases of severe, prolonged cholestasis after treatment with trimethoprim sulfamethoxazole; intractable pruritus and abnormal liver test results lasted for 1-2 years after discontinuation of the drug. Liver biopsy specimens showed a cholestatic pattern of liver injury and only minimal hepatocellular necrosis or inflammation. Recent case reports suggest that cholestasis alone may occur after the use of trimethoprim sulfamethoxazole; these two additional cases show that cholestasis may be quite prolonged.
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Affiliation(s)
- K V Kowdley
- Division of Gastroenterology, New England Medical Center, Boston, Massachusetts
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Affiliation(s)
- U K Singh
- Department of Pediatrics, Patna Medical College Hospital
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Muñoz SJ, Martinez-Hernandez A, Maddrey WC. Intrahepatic cholestasis and phospholipidosis associated with the use of trimethoprim-sulfamethoxazole. Hepatology 1990; 12:342-7. [PMID: 2167870 DOI: 10.1002/hep.1840120223] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Although liver injury after administration of the trimethoprim-sulfamethoxazole combination is rare, hepatocellular necrosis and cholestasis have developed in a few cases. We describe a patient who developed a severe, prolonged cholestatic reaction after trimethoprim-sulfamethoxazole administration. The findings from serial liver biopsy samples showed characteristic abnormalities of phospholipidosis that have not been previously described for trimethoprim-sulfamethoxazole-related hepatic injury. The most prominent finding on electron microscopic evaluation of the liver was the presence of prominent hepatocyte lysosomal inclusions characterized by concentric arrangements of membranous and lamellated structures. The patient improved after several courses of exchange plasmapheresis, which may have assisted in the removal of toxic drug-lipid complexes. The pathogenesis of this acquired secondary phospholipidosis is unknown. Possible mechanisms include generation of highly lipid-soluble metabolites and inhibition of the lysosomal enzyme phospholipase A1.
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Affiliation(s)
- S J Muñoz
- Department of Medicine, Jefferson Medical College, Philadelphia, Pennsylvania 19107
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Garabedian-Ruffalo SM, Ruffalo RL. Drug-induced jaundice. An uncommon but puzzling reaction. Postgrad Med 1988; 84:205-10, 213. [PMID: 3050930 DOI: 10.1080/00325481.1988.11700445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Drug-induced jaundice is relatively uncommon but can be a diagnostic puzzle. Because so many pharmaceutical classes and individual agents can produce jaundice, a thorough history of medications taken should be obtained from a patient presenting with jaundice. Jaundice usually resolves when the offending agent is discontinued.
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Abstract
Acute, drug-induced hepatocellular cholestasis (either pure or cholestatic hepatitis) is a common manifestation of drug-induced hepatic injury. The drugs most frequently responsible are hormonal steroids and psychopharmacological agents (in particular phenothiazines and some antidepressants). Cholestasis usually subsides without sequelae in less than six months. Acute, drug-induced ductular cholestasis is uncommon and can resemble biliary tract obstruction. Complete recovery occurs promptly after the withdrawal of the causative drug in most cases. The pathogenetic mechanism may be immunoallergic. Prolonged ductular or ductal cholestasis can follow drug-induced acute hepatitis despite prompt withdrawal of the offending drug. This syndrome, observed mainly with chlorpromazine and uncommonly with twenty other drugs, is characterized by the progressive disappearance of small bile ducts and by manifestations mimicking primary biliary cirrhosis. However, its prognosis appears to be better than that of primary biliary cirrhosis, the condition being reversible in the majority of cases or even subsiding completely. The mechanism is still unknown, but several features suggest some form of autoimmunity. Extrahepatic cholestasis related to sclerosing cholangitis is a frequent and long-term complication of intra-arterial infusion of floxuridine in patients treated for hepatic metastases from colorectal carcinoma. Although it may be reversible, floxuridine-induced sclerosing cholangitis has a poor prognosis and can lead to death in a few patients. The mechanism is probably related to the vascular supply of the common hepatic duct and its relationship to the perfusion territory of floxuridine.
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