Azithromycin-Induced Hepatotoxicity

Abstract

Objective To report a case of hepatotoxicity in a patient receiving azithromycin. Case Summary A 38-year-old female was admitted for an acute exacerbation of her liver disease. The patient received a course of azithromycin 2 weeks prior to admission for a respiratory tract infection. On admission, the patient had elevated liver function tests (LFTs), ascites, jaundice with sclera icterus, and abdominal pain. Etiologies such as infection and worsening liver disease were ruled out, and the patient's symptoms and transaminitis were attributed to azithromycin-induced hepatotoxicity. The patient was medically managed with diuretics and discharged after the symptoms stabilized and LFTs were trending down. Discussion There are 6 previous case reports of patients experiencing azithromycin-induced hepatotoxicity. The patient's presentation and onset of symptoms after azithromycin initiation were similar to other patients. Although this patient had a history of steatohepatitis, progression of liver disease was ruled out and other etiologies were considered unlikely. The patient's laboratory values supported cholestatic liver injury, and the most likely cause of the transaminitis and symptoms was attributed to azithromycin. Although azithromycin is usually well-tolerated and liver injury is a rare adverse effect, there is increasing literature surrounding azithromycin-induced hepatotoxicity. The Naranjo adverse drug reaction probability scale revealed a possible interaction between azithromycin and the hepatotoxic adverse event. Conclusions We report a possible case of azithromycin-induced hepatotoxicity. Even though hepatotoxicity is an uncommon side effect of azithromycin, prescribers should be cognizant of this potential adverse effect in order to discontinue therapy as necessary and prevent re-exposure to the medication.