Prolonged cholestasis after troleandomycin-induced acute hepatitis.

Area of Science:

• Hepatology
• Clinical Medicine
• Pharmacology

Background:

• Troleandomycin, a macrolide antibiotic, is known to cause drug-induced liver injury.
• Hepatitis associated with troleandomycin can manifest with cholestatic features.

Observation:

• A patient developed troleandomycin-induced hepatitis with jaundice and hypereosinophilia.
• Following resolution of jaundice, the patient experienced prolonged anicteric cholestasis.
• This cholestatic phase was characterized by pruritus and elevated liver enzymes (alkaline phosphatase, gammaglutamyltransferase).

Findings:

• Jaundice resolved within 3 months, but cholestasis persisted for 19 months.
• Complete normalization of liver tests occurred 27 months after the initial hepatitis onset.
• This case demonstrates a protracted course of cholestasis post-troleandomycin hepatitis.

Implications:

• Drug-induced liver injury from antibiotics like troleandomycin can have prolonged and complex clinical courses.
• Extended monitoring for liver function is crucial in patients with antibiotic-associated cholestasis.
• Understanding the long-term sequelae of drug-induced hepatitis is important for patient management and risk assessment.