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Fusidic acid-induced hyperbilirubinemia.

K P Kutty, I V Nath, K R Kothandaraman

    Digestive Diseases and Sciences
    |August 1, 1987
    PubMed
    Summary
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    Fusidic acid, an antibiotic, can cause jaundice in patients, characterized by conjugated hyperbilirubinemia and mild liver enzyme elevations. Liver biopsy revealed cholestatic injury, suggesting a direct drug effect.

    Area of Science:

    • Hepatology
    • Pharmacology
    • Gastroenterology

    Background:

    • Fusidic acid is a widely used antibiotic, primarily for Staphylococcal infections.
    • Osteomyelitis is a common indication for fusidic acid therapy.
    • Drug-induced liver injury (DILI) is a significant concern in clinical practice.

    Observation:

    • A 72-year-old male developed jaundice during fusidic acid treatment for osteomyelitis.
    • Laboratory tests showed predominantly conjugated hyperbilirubinemia with mild, transient liver enzyme elevations.
    • Liver biopsy revealed characteristic cholestatic changes, including bile plugs and canalicular damage.

    Findings:

    • The patient's jaundice resolved gradually after discontinuing fusidic acid, indicating a drug-related etiology.

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  • Histopathological findings on liver biopsy were consistent with drug-induced cholestasis.
  • Electron microscopy demonstrated specific ultrastructural changes in the bile canaliculi.

    • Implications:

    • Fusidic acid should be considered a potential cause of cholestatic jaundice.
    • This case highlights the importance of monitoring liver function during fusidic acid therapy.
    • Further research into the mechanisms of fusidic acid-induced hepatotoxicity is warranted.