Massive hepatic enlargement with fatty change associated with ketoconazole

Several forms of hepatic toxicity have been described with the antifungal agent ketoconazole. We report a case of massive liver enlargement with fatty infiltration presenting as gastric compression. This occurred in a young woman with AIDS taking ketoconazole as maintenance therapy for cryptococcal meningitis. This is the first reported case of ketoconazole causing fatty change in the liver.