Severe penicillin-induced cholestasis in a 91-year-old woman

An elderly woman was admitted for treatment of severe stasis ulceration, associated with varicose veins. One course of cloxacillin was given orally followed by a second course of penicillin-G to eradicate persistant hemolytic streptococcal skin infection. Deep progressive jaundice subsequently developed due to intrahepatic cholestasis and persisted for several weeks before resolution. Having excluded a progressive extrahepatic malignant lesion by appropriate investigations, the diagnosis was substantiated by classical changes present in a percutaneous liver biopsy.