Mixed hepatocellular-cholestatic liver injury from cefepime: A case report

Cefepime is a fourth-generation cephalosporin antibiotic widely used to treat a variety of serious bacterial infections, including febrile neutropenia, pneumonia, complicated intra-abdominal infections, urinary tract infections, and skin infections. It possesses broad-spectrum action against both gram-positive and gram-negative bacteria, with favorable pharmacokinetics and clinical efficacy, making it a cornerstone in the management of infections, especially in the hospital setting, where resistant organisms are prevalent. Well-known adverse effects include local reactions, gastrointestinal symptoms, and neurologic complications. However, instances of liver injury are rare.

We report the case of a 73-year-old male who presented to the emergency department (ED) with a 1-week history of productive cough, shortness of breath, and fatigue. Laboratory findings in the ED included leukocytosis, hyponatremia, and elevated procalcitonin. Computed tomography chest without contrast showed a new right-sided pleural effusion and worsening consolidative opacities in both lungs. He was admitted and started vancomycin and cefepime for infected bronchiectasis. Liver function tests subsequently worsened and improved with the discontinuation of cefepime. The patient ultimately died from acute hypoxic respiratory failure two weeks after hospitalization.

This case report highlights a rare adverse effect of a commonly used antimicrobial in the hospital setting for various bacterial infections. Prompt cessation of the medication is the primary treatment in cefepime-induced liver injury, and most cases resolve without complications.