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A case of meropenem-induced liver injury and jaundice
Szeya Cheung1, Jennifer Bulovic1, Ajish Pillai2
1Department of Medicine, Long Island Community Hospital, Patchogue, NY, USA.
Abstract:
This report describes what we believe is the first reported case of clinically significant cholestasis and acute liver injury within three days of meropenem therapy. An 83-year-old Hispanic female was admitted for sepsis of unknown origin and was started on intravenous meropenem. Three days following initiation of the antibiotic, the patient developed mixed hepatocellular and cholestatic liver injury with jaundice and pruritus. Possible causes of cholestasis were excluded after extensive investigations. A drug-induced liver injury was suspected and meropenem was discontinued. Following discontinuation of meropenem, the patient demonstrated symptomatic and laboratory improvements, and her liver enzymes and bilirubin levels were normalized.
Insights
This case report details the first known instance of significant liver injury and cholestasis linked to meropenem antibiotic treatment. Discontinuation of meropenem led to the patient's recovery, highlighting potential drug-induced liver injury.
Area of Science:
- Hepatology
- Clinical Pharmacology
- Infectious Diseases
Background:
- Meropenem is a broad-spectrum carbapenem antibiotic commonly used for severe bacterial infections.
- Drug-induced liver injury (DILI) is a significant concern in clinical practice, with various antimicrobial agents implicated.
- Cholestasis, characterized by impaired bile flow, can lead to jaundice and pruritus, and may result from DILI.
Observation:
- An 83-year-old female patient developed sepsis and was treated with intravenous meropenem.
- Within three days of meropenem initiation, the patient exhibited signs of acute liver injury, including jaundice and pruritus.
- The liver injury presented as a mixed hepatocellular and cholestatic pattern.
Findings:
- Extensive investigations ruled out other common causes of cholestasis.
- A diagnosis of meropenem-induced liver injury was suspected.
- Discontinuation of meropenem resulted in significant clinical and laboratory improvement.
Implications:
- This case highlights meropenem as a potential cause of clinically significant cholestatic and hepatocellular liver injury.
- Early recognition and withdrawal of the offending agent are crucial for managing drug-induced liver injury.
- Further pharmacovigilance is warranted to monitor for meropenem-associated hepatotoxicity.
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