Amoxicillin
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Cholestatic hepatitis: case report A 34-year-old woman developed cholestatic hepatitis after receiving amoxicillin for intercurrent dental surgery. The woman received a 10-day course of amoxicillin 1000mg twice daily on 20 February 2007, and developed pruritus and weakness 6 days later [route not stated]. She was admitted for malaise and jaundice on 20 March. Jaundice was evident on admission, and laboratory examinations revealed the following: total serum bilirubin 521 µmol/L (direct 444 µmol/L), ALT 56 IU/mL, AST 42 IU/mL, GGT 242 IU/mL, ALP 647 IU/mL and positive antimitochondrial antibodies. A liver biopsy revealed portal tract lymphocytic inflammatory infiltration, marked cholestasis in the hepatocytes, and cholangitis; findings were deemed consistent with primary biliary cirrhosis. The woman was prescribed ursodeoxycholic acid, and her liver function tests normalised after 8 weeks, and her antimitochondrial antibodies were negative; ursodeoxycholic acid was withdrawn. Six months later, the woman presented with malaise and jaundice 3 days after receiving amoxicillin. Her direct bilirubin, ALP and GGT levels had increased, and she had positive antimitochondrial antibodies. After having jaundice for 1 month, her bilirubin and ALP levels decreased and subsequently normalised. She continued to be well without signs of liver damage at 2 years’ follow-up. Author comment: "The clinical course and laboratory data observed in this case are compatible with the diagnosis of severe acute cholestatic hepatitis, probably due to amoxicillin. [T]he temporal correlation between the clinical bouts of cholestatic damage and remission upon drug cessation strongly suggests amoxicillin as the most plausible explanation for this patient’s clinical and laboratory presentation." Chaabane NB, et al. Cholestatic hepatitis related to amoxicillin. Drug and Chemical Toxicology 34: 357-358, No. 4, Oct 2011. Available from: URL: http:// 803062402 dx.doi.org/10.3109/01480545.2010.545067 - Tunisia
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Reactions 12 Nov 2011 No. 1377
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