Worsening cholestasis and possible cefuroxime-induced liver injury following "successful" therapeutic endoscopic retrograde cholangiopancreatography for a distal common bile duct stone: a case report. (December 2016)

• Record Type: Journal Article
• Authors: Niriella, Madunil; Kumarasena, Ravindu; Dassanayake, Anuradha; Pathirana, Aloka; de Silva Hewavisenthi, Janaki; de Silva, Hithanadura
• Is Part Of: Journal of medical case reports. Volume 10:Number 1(2016)
• Page Start: 1
• Page End: 4
• Publication Date: 2016-12
• Subjects: Cefuroxime -- Drug-induced liver injury -- Cholestasis -- ERCP; Medicine -- Research -- Periodicals; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1186/s13256-016-1123-0
• Languages: English
• ISSNs: 1752-1947

Abstract

Abstract Background Cefuroxime very rarely causes drug-induced liver injury. We present a case of a patient with paradoxical worsening of jaundice caused by cefuroxime-induced cholestasis following therapeutic endoscopic retrograde cholangiopancreatography for a distal common bile duct stone. Case presentation A 51-year-old, previously healthy Sri Lankan man presented to our hospital with obstructive jaundice caused by a distal common bile duct stone. Endoscopic retrograde cholangiopancreatography with stone extraction, common bile duct clearance, and stenting failed to improve the cholestasis, with paradoxical worsening of his jaundice. A liver biopsy revealed features of drug-induced intrahepatic cholestasis. Although his case was complicated by an episode of cholangitis, the patient made a complete recovery in 4 months with supportive treatment and withdrawal of the offending drug. Conclusions This case highlights a very rare drug-induced liver injury caused by cefuroxime as well as our approach to treating a patient with paradoxical worsening of jaundice after therapeutic endoscopic retrograde cholangiopancreatography.