Cefdinir-Induced Liver Injury: A Case Report

Cephalosporins are very rarely known to cause drug-induced liver injury (DILI). We present the case of a healthy 40-year-old female who developed DILI after completing a course of cefdinir, a third-generation cephalosporin, to treat a urinary tract infection. A 40-year-old female with no past medical history presented to the emergency department with a chief complaint of epigastric pain and jaundice for the last four days. A workup at an urgent care revealed hyperbilirubinemia and elevated liver enzymes, prompting this visit. She had completed a five-day course of cefdinir for a urinary tract infection three weeks prior to her visit. Physical examination revealed a vitally stable patient with scleral icterus and no other positive findings. Laboratory workup was significant for total bilirubin 4.3 mg/dL, direct bilirubin 0.7 mg/dL, ALP 130 unit/L, ALT 546 unit/L, and AST 213 unit/L. Serum hepatitis panel, ferritin, ceruloplasmin, alpha-1 antitrypsin, and autoimmune workup were within normal limits. Ultrasound and CT of the abdomen and magnetic resonance cholangiopancreatography did not reveal any pathology. Liver biopsy demonstrated hepatocellular adaptive changes and mild bile duct epithelial damage, suggestive of DILI. This case highlights the importance of obtaining a thorough medical history, including recent medication use, drug dose, and time of symptom onset, for a patient presenting with elevated liver enzymes. This case also emphasizes keeping a broad list of differential diagnoses when managing patients with elevated liver enzymes.