Moxifloxacin
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Fatal hepatotoxicity in an elderly patient: case report A 72-year-old man developed fatal hepatoxicity after receiving moxifloxacin during treatment for an acute exacerbation of chronic bronchitis. The man presented with generalised weakness, increasing fatigue, leg oedema and jaundice of 10 days’ duration. His medical history was notable for chronic obstructive pulmonary disease, rheumatoid arthritis and remote history of skin cancer; current medications included tiotropium bromide, salmeterol/fluticasone propionate and salbutamol [albuterol] (all via inhalers), folic acid and low-dose methotrexate. Recently he received steroids, bronchodilators and moxifloxacin [dosage not stated] for 5 days for acute bronchitis. About 1 week posttreatment, his wife had noticed yellowing of his eyes and skin [time to reaction onset not clearly stated]. He was admitted to an ICU for monitoring. Examination on presentation was notable for scleral icterus; chest and cardiac examinations were normal while marked epigastric tenderness and mild right upper quadrant tenderness were evident on abdominal examination. Also, he had pitting pedal oedema bilaterally. Laboratory investigations revealed the following values: WBC 2.6; platelets 13 000; haemoglobin 11.2, haematocrit 32.3; AST 150, ALT 193, ALP 337, LDH 169, total bilirubin 29.0, blood urea nitrogen 72, creatinine 2.8, sodium 134, potassium 5.2, total protein 4.4, albumin 2.8 and CRP 0.7. Pancytopenia without atypical cells was evident on peripheral blood smear. Blood cultures were negative, as were the results of tests for an infectious cause. Abdominal and pelvic CT scans showed mild splenomegaly and nonobstructive gallstones without cholecystitis; there were no signs indicative of sepsis or hepatic failure. Despite full supportive care, the man’s liver function continued to deteriorate. Methotrexate was withheld due to the increased liver enzyme levels. Following all investigations, his acute liver failure was diagnosed as an idiosyncratic reaction to moxifloxacin. He subsequently died due to multiple organ failure. Verma R, et al. Moxifloxacin induced fatal hepatotoxicity in a 72-year-old man: a case report. Cases Journal 2: No. 7, 2009. Available from: URL: http:// 803010887 dx.doi.org/10.4076/1757-1626-2-8063 - USA
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Reactions 17 Apr 2010 No. 1297
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