[Severe liver damage as a drug-allergy reaction to cefoperazone]

A 20 year old man was treated with cefoperazone for 25 days because of a local infection after an open fracture complicated by pseudarthrosis. Severe liver damage was noted on 25th day of cefoperazone treatment. There was extreme elevation of transaminases and alkaline phosphatasis as well as jaundice and prolonged prothrombin time. Upper GI bleeding, fever and acute renal failure developed. All symptoms disappeared after cessation of cefoperazone. A causal relationship between the drug and liver damage seems likely because of a positive lymphocyte stimulation test, the time relation between cefoperazone therapy and change in liver function as well as the development of eosinophilia. Other causes of liver damage could be excluded. The pathogenesis of liver damage, upper GI bleeding and acute renal failure is discussed.