Acute hepatitis attack after exposure to telithromycin

Area of Science:

• Pharmacology
• Hepatology
• Clinical Toxicology

Background:

• Antibiotic-associated hepatotoxicity is a rare but serious adverse drug reaction.
• Idiosyncratic hepatic injury from antimicrobial agents can occur despite widespread use.
• Ketolide antibiotics, like telithromycin, are used for respiratory tract infections.

Observation:

• A 25-year-old male presented with jaundice, malaise, nausea, and vomiting after a 7-day course of telithromycin.
• Laboratory tests revealed elevated liver enzymes (ALT, AST, ALP) and direct bilirubin.
• The patient had a prior episode of hepatitis of unknown origin after telithromycin use within the past year.

Findings:

• Telithromycin was identified as the probable cause of acute hepatitis based on the Naranjo scale (score 8).
• Pathological findings were consistent with drug-induced toxic hepatitis.
• The patient experienced recurrent hepatitis, suggesting a potential link to repeated telithromycin exposure.

Implications:

• This case underscores the risk of severe hepatic dysfunction associated with telithromycin.
• Physician awareness and patient reporting of adverse drug reactions are crucial for preventing recurrence.
• Effective communication regarding prior drug-induced hepatitis is vital for patient safety.