LIVER TRANSPLANTATION AND DEATH WITHIN 4 MONTHS OF SUSPECTED DRUG-INDUCED LIVER INJURY (DILI) FROM AMOXICILLIN

Abstract

Introduction Antibiotic prescription is not without risk. We present a case of suspected Drug induced liver injury (DILI) secondary to amoxicillin. Case Description An 18-year-old African American male presents from an outside hospital for acute liver failure. Initially, he reports developing “yellow eyes” on day 5 of taking amoxicillin, which was prescribed by his primary care provider for sore throat and a positive rapid strep test. He is an athlete with no significant medical history or antibiotic use prior to this encounter. He does not drink alcohol, smoke or do illicit drugs. Extensive workup following the AASLD (American Association for Study of Liver Diseases) guidelines was unremarkable for biliary, autoimmune, infectious, genetic, obstructive, veno-occlusive, alcohol or salicylic acid-induced causes. Laboratory tests show a hepatocellular pattern without significant peripheral eosinophilia (AEC 110). The patient receives a liver transplant but has a hospital course complicated by bacteremia and multi-organ failure resulting in death. Discussion There is yet to be a reliable method to predict, diagnose, and risk assess DILI. The two most common causes of DILI are acetaminophen and amoxicillin-clavulanic acid. Amoxicillin alone is less likely to cause DILI, although it may, and it can be associated with a mixed hepatocellular/cholestatic picture. The chronologic association between initiation of antibiotic and the onset of liver injury is pertinent. Immediate hypersensitivity reactions are IgE mediated and can occur within 1 hour after last drug administration. Delayed reactions are often T lymphocyte specific and can occur more than 1 hour after the last drug administration.