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Bismuth Subcitrate, Metronidazole and Tetracycline - A Rare Cause of Drug-Induced Liver Injury

Carina Silva1, Susana Merim1, Rita Sevivas1

  • 1Internal medicine department, Hospital Santa Maria Maior, Barcelos, Portugal.

European Journal of Case Reports in Internal Medicine
|December 11, 2023
PubMed

Insights

Drug-induced liver injury (DILI) can result from various medications. A rare case highlights bismuth subcitrate, metronidazole, and tetracycline combination therapy as a potential cause of DILI, emphasizing its diagnosis by exclusion.

Area of Science:

  • Hepatology
  • Pharmacology
  • Internal Medicine

Background:

  • Drug-induced liver injury (DILI) encompasses a wide range of liver damage caused by medications or toxins.
  • Antibiotics are a significant category of drugs associated with DILI.
  • DILI diagnosis is typically made after excluding other potential causes of liver dysfunction.

Purpose of the Study:

  • To report a rare case of DILI.
  • To identify a specific drug combination as a potential cause of DILI.
  • To underscore the diagnostic process for DILI.

Main Methods:

  • Clinical case presentation of a 37-year-old male with acute hepatitis symptoms.
  • Exclusion of viral, autoimmune, hemochromatosis, and Wilson's disease etiologies.
  • Confirmation of DILI through liver biopsy.

Main Results:

  • The patient presented with nausea, right hypochondrium pain, and fever following a five-day course of bismuth subcitrate, metronidazole, and tetracycline.
  • Liver biopsy findings were consistent with DILI.
  • Other causes of acute hepatitis were ruled out.

Conclusions:

  • The combination of bismuth subcitrate, metronidazole, and tetracycline is an uncommon cause of DILI.
  • DILI is a diagnosis of exclusion, requiring thorough investigation.
  • Liver biopsy plays a crucial role in confirming DILI when clinical suspicion is high.
Keywords:
Bismuth subcitratedrug-induced liver injurymetronidazoletetracycline

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