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Severe Case of Cholestatic Hepatitis From Amoxicillin/Clavulanic Acid

Lokesh Goyal1, Anirudh K Madabhushi2, Mariam S Siddiqi2

  • 1Hospital Medicine, CHRISTUS Spohn Hospital, Corpus Christi, USA.

Cureus
|July 11, 2022
PubMed

Insights

Amoxicillin/clavulanate (Augmentin) can cause liver injury, though rare. This case highlights severe cholestatic hepatitis in a patient treated for a dog bite.

Area of Science:

  • Hepatology
  • Pharmacology
  • Infectious Diseases

Background:

  • Amoxicillin/clavulanate is a widely prescribed antibiotic for bacterial infections.
  • While generally safe, it can lead to adverse effects including gastrointestinal issues, rash, and thrombocytopenia.
  • Drug-induced liver injury (DILI) from amoxicillin/clavulanate is uncommon but can be severe.

Observation:

  • A 63-year-old male presented with severe cholestatic hepatitis, nausea, and pruritus.
  • The patient had recently been treated with amoxicillin/clavulanate for a dog bite.
  • Symptoms appeared four weeks after initiating antibiotic treatment.

Findings:

  • The case demonstrates a severe instance of amoxicillin/clavulanate-induced liver injury.
  • Cholestatic hepatitis was the primary manifestation of the adverse drug reaction.
  • The temporal relationship suggests a causal link between the antibiotic and the liver injury.

Implications:

  • This case underscores the importance of monitoring liver function in patients receiving amoxicillin/clavulanate, especially with prolonged use.
  • Clinicians should consider amoxicillin/clavulanate as a potential cause of cholestatic hepatitis in patients with compatible symptoms.
  • Further research into the mechanisms and risk factors for amoxicillin/clavulanate hepatotoxicity is warranted.
Keywords:
abdominal painalkaline phosphatase (alp)drug-induced hyperbilirubinemiahepatitisnausea and vomiting

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