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Michelle Meier1,2, Peter Lykke Eriksen3,4
1Mave- og Tarmkirurgisk Afdeling, Regionshospitalet Randers.
Ugeskrift for Laeger
|June 7, 2024
Summary
Amoxicillin/clavulanate, a common antibiotic, can cause rare but severe drug-induced liver injury. This case highlights a fatal outcome in an elderly woman despite supportive care, emphasizing diagnostic challenges.
Area of Science:
- Pharmacology
- Hepatology
- Internal Medicine
Background:
- Amoxicillin/clavulanate is a widely prescribed antibiotic.
- Idiosyncratic drug-induced liver injury (iDILI) from amoxicillin/clavulanate is rare but has the highest incidence among antibiotics.
- Early recognition and management of amoxicillin/clavulanate-induced liver injury are crucial.
Observation:
- An 80-year-old woman presented with malaise and icterus after treatment for a respiratory tract infection with amoxicillin/clavulanate.
- Biochemical tests revealed a cholestatic pattern with elevated alkaline phosphatase and bilirubin.
- The clinical presentation was diagnostically challenging.
Findings:
- Liver biopsy confirmed drug-induced liver injury (DILI).
- Despite supportive and symptomatic treatment, the patient experienced a fatal course.
- This case underscores the potential severity of amoxicillin/clavulanate-induced liver injury.
Implications:
- Clinicians should maintain a high index of suspicion for amoxicillin/clavulanate-induced liver injury in patients presenting with cholestatic jaundice.
- Prompt cessation of the offending drug and appropriate management are critical.
- Further research into the mechanisms and prediction of idiosyncratic drug reactions is warranted.