Daptomycin-Induced Acute Renal and Hepatic Toxicity Without                     Rhabdomyolysis

Objective: To report a case of a patient who experienced acute renal and hepatic toxicity following administration of daptomycin and review previously published case reports of renal and hepatic dysfunction with daptomycin. Case Summary: A 35-year-old man receiving daptomycin 4 mg/kg (275 mg) intravenously once daily (started 5 wk prior to presentation for presumed osteomyelitis) presented to the emergency department with elevations in serum creatinine and hepatic transaminase levels. He did not experience creatine kinase (CK) elevation or rhabdomyolysis. Following discontinuation of daptomycin, his renal and hepatic function improved. Discussion: To our knowledge, this is the first case of daptomycin-induced hepatotoxicity with acute renal failure in the absence of rhabdomyolysis and CK abnormalities. Previously published case reports described patients with a variety of elevations in liver function tests, serum creatinine, and CK with daptomycin. In our patient, the acute renal and hepatic toxicity was probable according to the Naranjo probability scale. Conclusions: Although daptomycin is a well-tolerated antibacterial agent, clinicians should consider periodic monitoring of liver function and renal function tests to identify potential adverse effects.

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Gilbert Syndrome in a Young Ethiopian Man: First Case Report

Ethiopian Journal of Health Sciences ◽

10.4314/ejhs.v31i1.23 ◽

2021 ◽

Vol 31 (1) ◽

Author(s):

Amir Sultan ◽

Kibrewossen Kiflu

Keyword(s):

Case Report ◽

Liver Function ◽

Male Patient ◽

Liver Function Tests ◽

Prolonged Fasting ◽

Unconjugated Hyperbilirubinemia ◽

Gilbert Syndrome ◽

Function Tests ◽

First Case

BACKGROUND፡ Gilbert syndrome is a well-recognized condition causing unconjugated hyperbilirubinemia with otherwise normal transaminases and liver function tests. CASE: A 21 year old male patient presented with recurrent episodes of jaundice over four years. The episodes were preceded by stressful conditions and intercurrent illnesses. All laboratory prameters were normal except an unconjugated hyperbilirubinemia. A diagnosis of Gilbert syndrome was made after careful clinical evaluation.CONCLUSION: Recognizing Gilbert syndrome has important clinical implicaitions by avoiding uncessary and expensive workup of patients with jaundice. Mangement entails avoiding stressful conditions and prolonged fasting.

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Colchicine-Induced Rhabdomyolysis

Annals of Pharmacotherapy ◽

10.1345/aph.1a288 ◽

2002 ◽

Vol 36 (5) ◽

pp. 824-826 ◽

Cited By ~ 21

Author(s):

Kellie H Boomershine

Keyword(s):

Renal Failure ◽

Creatine Kinase ◽

Chronic Renal Failure ◽

Liver Function ◽

Case Reports ◽

Liver Function Tests ◽

Causative Factor ◽

Function Tests ◽

Elevated Liver Function Tests ◽

New Skin

OBJECTIVE: To report a case of rhabdomyolysis occurring during treatment with colchicine. CASE SUMMARY: A 44-year-old African American man was admitted to the hospital due to persistent diarrhea, vomiting, and diffuse weakness. Past medical history was significant for renal failure requiring peritoneal dialysis, gout, and a new skin lesion. Approximately 2 months prior to admission, he had been started on colchicine and allopurinol. Creatine kinase concentration on admission was >14 000 U/L. Liver function tests were elevated 5 × the upper limit of normal. Colchicine was discontinued on admission. Creatine kinase concentrations decreased significantly, and strength and ambulation improved throughout hospitalization. DISCUSSION: Colchicine was thought to be the causative factor for rhabdomyolysis in conjunction with chronic renal failure and elevated liver function tests. After discontinuation of colchicine, creatinine kinase concentrations declined and the patient's ability to walk improved. Limited case reports of colchicine-induced rhabdomyolysis have been published. CONCLUSIONS: Chronic renal failure in conjunction with elevated liver function tests appear to increase the possibility of colchicine-induced toxicity, specifically, rhabdomyolysis.

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Comparative effect of desflurane and sevoflurane on liver function tests of patients with impaired hepatic function undergoing cholecystectomy: A randomized clinical study

Indian Journal of Anaesthesia ◽

10.4103/ija.ija_168_20 ◽

2020 ◽

Vol 64 (5) ◽

pp. 383

Author(s):

Rabie Soliman ◽

Abdelbadee Yacoub ◽

Mostafa Abdellatif

Keyword(s):

Clinical Study ◽

Liver Function ◽

Liver Function Tests ◽

Hepatic Function ◽

Comparative Effect ◽

Randomized Clinical Study ◽

Impaired Hepatic Function ◽

Function Tests

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Hepatic function in the critically ill

10.1093/med/9780199600830.003.0175 ◽

2016 ◽

Author(s):

Andreas Kortgen ◽

Michael Bauer

Keyword(s):

Blood Flow ◽

Liver Function ◽

Critically Ill ◽

Liver Blood Flow ◽

Prognostic Significance ◽

Liver Function Tests ◽

Hepatic Function ◽

Prognostic Information ◽

Hepatocellular Damage ◽

Function Tests

The liver with its parenchymal and non-parenchymal cells plays a key role in the organism with manifold functions of metabolism, synthesis, detoxification, excretion, and host response. This requires a portfolio of different tests to obtain an overview of hepatic function. In the critically ill hepatic dysfunction is common and potentially leading to extrahepatic organ dysfunctions culminating in multi-organ failure. Conventional laboratory measures are used to evaluate hepatocellular damage, cholestasis, or synthesis. They provide valuable (differential) diagnostic data and can yield prognostic information in chronic liver diseases, especially when used in scoring systems such as the ‘model for end-stage liver disease’. However, they have short-comings in the critically ill in assessing rapid changes in hepatic function and liver blood flow. In contrast, dynamic quantitative liver function tests measure current liver function with respect to the ability to eliminate and/or metabolize a specific substance. In addition, they are dependent on sinusoidal blood flow. Liver function tests have prognostic significance in the critically ill and may be used to guide therapy.

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Terbinafine used safely in autoimmune hepatitis for treatment of tinea corporis

BMJ Case Reports ◽

10.1136/bcr-2021-243143 ◽

2021 ◽

Vol 14 (5) ◽

pp. e243143

Author(s):

Jessica Elizabeth Ferguson ◽

Megan Prouty

Keyword(s):

Liver Disease ◽

Patient Education ◽

Liver Function ◽

Autoimmune Hepatitis ◽

Signs And Symptoms ◽

Liver Function Tests ◽

Tinea Corporis ◽

Function Tests ◽

First Case ◽

Oral Terbinafine

Terbinafine is often considered contraindicated in those with liver disease, as one of the known side effects is hepatotoxicity. We report the first case documenting the safe use of oral terbinafine in a 77-year-old woman with stable autoimmune hepatitis presenting with extensive tinea corporis. Precautions were carried out to minimise the risk of worsening hepatotoxicity, including consultation with the patient’s hepatologist, limiting terbinafine exposure to less than 6 weeks, monitoring of liver function tests, and patient education. The patient’s fungal infection cleared without any signs or symptoms of worsening liver disease. The rash had not recurred 6 months after treatment. When terbinafine must be used in a patient with pre-existing liver disease, we recommend considering a short course of oral terbinafine after consultation with their hepatologist, obtaining baseline liver function tests with consideration of further monitoring during treatment course, and patient education on the signs and symptoms of liver injury.

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Histologic patterns of liver injury induced by anti-PD-1 therapy

Gastroenterology Report ◽

10.1093/gastro/goz044 ◽

2019 ◽

Vol 8 (1) ◽

pp. 50-55 ◽

Cited By ~ 2

Author(s):

Dongwei Zhang ◽

John Hart ◽

Xianzhong Ding ◽

Xuchen Zhang ◽

Michael Feely ◽

...

Keyword(s):

Liver Injury ◽

Liver Function ◽

Autoimmune Hepatitis ◽

Gastrointestinal Symptoms ◽

Liver Function Tests ◽

Function Tests ◽

Immune Mediated ◽

Advanced Malignancies ◽

Periodic Monitoring ◽

History Of

Abstract Background Nivolumab and pembrolizumab—two monoclonal antibodies that block human programmed cell death-1 (PD-1)—have been successfully used to treat patients with multiple advanced malignancies. The histologic patterns of hepatic toxicity induced by anti-PD-1 treatment have not been well studied and the aim of this study was to explore them. Methods Eight patients with advanced malignancies who were treated with either nivolumab or pembrolizumab were identified from five institutions. These patients had no history of underlying liver disease and a viral hepatitis panel was negative in all patients. Results Seven of eight patients exhibited mild to moderate gastrointestinal symptoms such as abdominal pain, fatigue, nausea, vomiting, and jaundice after anti-PD-1 treatment. Significant elevations in liver-chemistry tests were detected in all patients. Six cases (6/8) demonstrated an acute lobular hepatitis pattern of histologic injury. The remaining two cases showed different histologic patterns of injury: steatohepatitis with mild cholestasis (1/8) and pure acute cholestatic injury (1/8). No case showed typical features of autoimmune hepatitis. The liver function recovered in all eight cases after cessation of anti-PD-1 agents and with immunosuppressive therapy. Conclusions Our study suggests that screening patients for abnormal liver-function tests prior to anti-PD-1 therapy as well as periodic monitoring of liver-function tests are necessary to prevent severe liver injury. Rather than causing classical autoimmune hepatitis, PD-1 inhibitors appear to produce an immune-mediated nonspecific acute hepatitis. Drug cessation, without steroid therapy, may therefore be sufficient in some patients.

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