Reversible oxacillin-associated hepatitis in a 9-month-old boy

Area of Science:

• Pediatric Infectious Diseases
• Hepatology
• Clinical Pharmacology

Background:

• Osteomyelitis and septic arthritis are serious pediatric infections requiring prompt antibiotic treatment.
• Oxacillin is a common antibiotic used for Staphylococcus aureus infections, including bone and joint infections.
• Drug-induced liver injury (DILI) is a potential adverse effect of various medications, though rare in infants.

Observation:

• A 9-month-old boy receiving intravenous oxacillin for femoral osteomyelitis and hip septic arthritis developed acute hepatitis and a concurrent skin rash on day six.
• Other potential causes of hepatitis and rash, including viral infections and other drug reactions, were ruled out.
• The patient's clinical condition improved significantly after discontinuation of oxacillin and initiation of teicoplanin therapy.

Findings:

• The case presents the youngest reported instance of oxacillin-associated hepatitis in medical literature.
• The adverse event was directly linked to oxacillin therapy, given the temporal relationship and resolution upon drug substitution.
• Complete recovery without sequelae was achieved following the switch to teicoplanin.

Implications:

• This case highlights the importance of considering DILI, specifically oxacillin-induced hepatitis, in pediatric patients presenting with unexplained hepatitis and rash.
• Clinicians should maintain a high index of suspicion for drug-induced liver injury in infants receiving oxacillin.
• Further investigation into the mechanisms and incidence of oxacillin-related hepatotoxicity in pediatric populations may be warranted.