From Therapy to Toxicity: A Rare Case of Acute Piperacillin/Tazobactam-Associated Drug-Induced Liver Injury

Drug-induced liver injury (DILI) is a diagnosis of exclusion, but one that requires high clinical suspicion because prompt withdrawal of the offending agent is imperative to improve prognosis. Piperacillin/tazobactam (TZP) is a rare cause of clinically apparent liver injury. This case is an example of DILI caused by TZP that was identified when a hospitalized patient's liver enzymes greatly increased, and hepatic steatosis was subsequently seen on a computed tomography scan. The Roussel Uclaf Causality Assessment Method (RUCAM) score is a tool used to indicate the likelihood of DILI. In this case, the RUCAM score was 7, indicating that the causality assessment of the TZP as the cause of liver injury was probable. This case underscores the importance of maintaining a high index of suspicion for DILI, particularly in patients receiving extended courses of antibiotics, and highlights the need for routine liver function monitoring during therapy with agents known to carry hepatotoxic potential.