Unusual clinical course, Unusual or unexpected effect of treatment, Adverse events of drug therapy
Michael Schloss, Daniel Becak, Sebastian T. Tosto, Arash Velayati
Medical Student, Alabama College of Osteopathic Medicine, Dothan, AL, USA
Am J Case Rep 2018; 19:272-276
Available online: 2018-03-10
Levoﬂoxacin covers a broad spectrum of pathogens and is readily prescribed by clinicians. Hepatotoxicity is a known but unusual complication of levoﬂoxacin use. Here, we present a case of severe transaminitis caused by levofloxacin.
CASE REPORT: A young man in his thirties with a history of asthma, chronic alcoholism, methamphetamine intravenous drug abuse (IVDA), and non-compliant insulin-dependent diabetes mellitus (IDDM) presented to an emergency department with suicidal ideation. Vital signs were stable and the patient was noted to have cellulitis of the right forearm, for which cultures were drawn, and he received IV clindamycin. He was admitted to behavioral medicine for further care. Blood cultures were positive for gram-negative rods and he was transferred to the medicine ward. Cultures eventually grew Brevundimonas diminuta. Clindamycin was discontinued and he was started on levofloxacin. Transaminase levels measured soon after levoﬂoxacin administration showed aminotransferase levels raised to approximately 50 times baseline within a few days. Levoﬂoxacin was discontinued due to concern about drug-induced hepatotoxicity. After discontinuation, transaminase levels decreased immediately. Work-up for other causes of transaminitis revealed no other etiology.
CONCLUSIONS: Clinicians should remain mindful that levoﬂoxacin can induce hepatotoxicity in rare cases. In patients presenting with acute liver injury who have recently taken levoﬂoxacin, it would be wise to remain cognizant of the possibility of levoﬂoxacin-induced hepatotoxicity.
Keywords: drug-induced liver injury, Fluoroquinolones, Liver Failure, Acute