Supplementary Material for: A Patient with Nafcillin-Associated Drug-Induced Liver Failure
Rao Q.
Schuster I.
Seoud T.
Zarrabi K.
Goolsarran N.
10.6084/m9.figshare.5446993.v1
https://karger.figshare.com/articles/journal_contribution/Supplementary_Material_for_A_Patient_with_Nafcillin-Associated_Drug-Induced_Liver_Failure/5446993
<p>Nafcillin-induced acute liver injury is a rare and potentially fatal
complication that has been known since the 1960s but inadequately
studied. At this time, the only proven treatment is early
discontinuation of the drug. Because of the high prevalence of nafcillin
class antibiotic use in the United States, it is important for
clinicians to have a high clinical suspicion for this diagnosis. We
present a case of liver failure attributable to nafcillin use in a
68-year-old male with a history methicillin-sensitive <i>Staphylococcus</i>
and L3/L4 osteomyelitis. After starting long-term antibiotic therapy,
he presented with painless jaundice which necessitated discontinuation
of the drug. At the time of presentation, the patient’s lab work
exhibited a bilirubin/direct bilirubin of 9.4/8.2 mg/dL, alkaline
phosphatase of 311 IU/L, and aspartate transaminase/alanine transaminase
of 109/127 IU/L. The patient was switched to i.v. vancomycin given the
concern for drug-induced liver injury. Imaging did not show obstruction
of the hepatobiliary or pancreaticobiliary trees. Serology was
unremarkable for viral etiology, autoimmune processes, Wilson disease,
and hemochromatosis. A liver biopsy showed findings consistent with
drug-induced liver injury. The patient’s liver function tests peaked at
day 7 of admission and trended towards normal levels with cessation of
nafcillin therapy. The patient was discharged with a diagnosis of
nafcillin-induced acute liver injury. Our case highlights the importance
of early recognition of the diagnosis and careful monitoring of liver
function when nafcillin is employed in the clinical setting.</p>
2017-09-27 14:42:48
Nafcillin
Liver
Jaundice
Drug-induced liver injury