Acute Hepatocellular Injury Associated With Azithromycin

2020 ◽  
pp. 089719001989442 ◽  
Author(s):  
Carolyn A. Ellison ◽  
Sarah B. Blackwell
Keyword(s):  
Total Bilirubin ◽  
Liver Enzymes ◽  
Abdominal Ultrasound ◽  
International Normalized Ratio ◽  
Community Acquired Pneumonia ◽  
Hepatocellular Injury ◽  
The Third ◽  
Normal Limits ◽  
Elevated Liver Enzymes ◽  
Hospital Days

Purpose: A report of acute azithromycin-induced hepatocellular injury is described. Summary: An 83-year-old male was admitted with possible community-acquired pneumonia and received azithromycin and ceftriaxone. After 2 doses of azithromycin, the patient’s aspartate aminotransferase and alanine aminotransferase were greater than 3 times the upper limit of normal and continued to rise with subsequent doses. A diagnostic abdominal ultrasound revealed hepatomegaly. Total bilirubin remained within normal limits during the course. Rosuvastatin and fenofibrate were held on admission and were not resumed in the setting of elevated liver enzymes. Rivaroxaban was held in the setting of worsening renal function. Hepatitis serologies were negative. Liver enzymes, international normalized ratio (INR), and activated partial thromboplastin time (aPTT) continued to climb until hospital day 5 when azithromycin was discontinued in response. Liver enzymes, INR, aPTT, and lactate dehydrogenase all decreased from hospital days 6 through 8. Conclusion: A potentially serious liver injury occurred with the initiation of azithromycin and began to resolve quickly after its discontinuation. While cholestatic injury with azithromycin is well described, this is only the third reported case of direct hepatocellular injury.

The Yield of Abdominal Ultrasound in the Evaluation of Elevated Liver Enzymes during the Second and the Third Trimester of Pregnancy

2017 ◽  
Vol 82 (5) ◽  
pp. 517-520
Author(s):  
Aya Mohr-Sasson ◽  
Eyal Schiff ◽  
Ramy Rahamim Suday ◽  
Zehava Hayman ◽  
Yeruham Kleinbaum ◽  
...  
Keyword(s):  
Liver Enzymes ◽  
Abdominal Ultrasound ◽  
Third Trimester ◽  
The Third ◽  
Elevated Liver Enzymes

Pattern and Significance of Asymptomatic Elevation of Liver Enzymes in Mycoplasma Pneumonia in Children

2017 ◽  
Vol 57 (1) ◽  
pp. 57-61 ◽  
Author(s):  
Deepti Jujaray ◽  
Liu Zheng Juan ◽  
Shraddha Shrestha ◽  
Ashiana Ballgobin
Keyword(s):  
Liver Enzymes ◽  
Diagnostic Procedures ◽  
Community Acquired Pneumonia ◽  
Benign Condition ◽  
Barr Virus ◽  
Elevated Liver Enzymes ◽  
Mycoplasma Pneumonia ◽  
Epstein Barr ◽  
Asymptomatic Elevation ◽  
Mycoplasma Pneumoniae Infection

Mycoplasma infection is on the rise in recent times. It usually infects any system, including liver. This study aims to show the significance of elevated liver enzymes in mycoplasma pneumonia and to have a look at future prospects. This is a single-center retrospective study involving 105 children serologically positive for mycoplasma IgM and IgG antibodies and 50 with community-acquired pneumonia caused by organisms other than mycoplasma and Epstein-Barr virus from June 2015 to June 2016 and all without prior liver disease. The patients were followed after 10 days (7-14 days). The liver enzymes were significantly elevated in Mycoplasma pneumoniae infection. The mean levels of alanine transaminase and aspartate transaminase were 39.3 and 32.5 IU/L, respectively. There was a seasonal variation during the months of September and February. Liver involvement in mycoplasma pneumonia is mostly a benign condition and asymptomatic. It is insisted that children with continued elevation should be followed conservatively to avoid unnecessary diagnostic procedures in the future.

scholarly journals Salmonella entericaSerotype Typhi Bacteremia Complicating Pregnancy in the Third Trimester

2017 ◽  
Vol 2017 ◽  
pp. 1-3 ◽  
Author(s):  
George F. Guirguis ◽  
Krunal Patel ◽  
Lisa Gittens-Williams ◽  
Joseph J. Apuzzio ◽  
Kristina Martimucci ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Salmonella Enterica ◽  
Liver Enzymes ◽  
Abdominal Discomfort ◽  
Third Trimester ◽  
Gram Negative ◽  
The Third ◽  
Elevated Liver Enzymes ◽  
Contaminated Food ◽  
In Pregnancy

Background.Salmonella entericaserotype Typhi (S.Typhi) is an anaerobic gram-negative enteric rod that causes infection when contaminated food or water is ingested and may cause illness in pregnancy.Case. This is a patient who presented at 31 weeks’ gestation with abdominal pain and fever and was diagnosed withS.Typhi bacteremia.Conclusion.S. Typhi should be considered in febrile patients with recent travel presenting with abdominal discomfort with or without elevated liver enzymes.

scholarly journals Amiodarone Hepatotoxicity with Absent Phospholipidosis and Steatosis: A Case Report and Review of Amiodarone Toxicity in Various Organs

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Adela Cimic ◽  
Joseph Sirintrapun
Keyword(s):  
Liver Enzymes ◽  
Smooth Muscle Antibody ◽  
Normal Limits ◽  
Hepatic Congestion ◽  
Elevated Liver Enzymes ◽  
Beta Globulin ◽  
Great Vessels ◽  
Cardiac Reconstruction ◽  
Mitochondrial Antibody ◽  
Immunoglobulin Levels

We present the first description of amiodarone toxicity in the liver without phospholipidosis or steatosis. In doing so, we will review the various effects of amiodarone toxicity in various organs. The patient is a young adult who had cardiac reconstruction as a child for transposition of the great vessels. A needle biopsy was taken due to elevated liver enzymes. Her ALT was 188 U/L (5–50) and AST 162 U/L (5–50). Alkaline phosphatase, total bilirubin, protein, and albumin were within normal limits. A serologic panel for viral hepatitis was negative. Antinuclear antibodies were positive at 260; however, anti-smooth muscle antibody and anti-mitochondrial antibody were negative. A protein electrophoresis showed a slightly elevated beta globulin 2 level of 0.5. Quantitative immunoglobulin levels were within normal limits except for a slightly elevated IgA 409 mg/dL (60–350). Liver ultrasound was unremarkable. The clinical differential was broad and included hepatic congestion along with autoimmune hepatitis. Sections showed only ballooned hepatocytes with Mallory-Denk bodies and perisinusoidal fibrosis. Arrival to the diagnosis was possible only after careful review of the patient’s medications. After discontinuation of amiodarone, the patient’s liver enzymes returned to normal levels.

scholarly journals Comparison between electrocautery and fibrin selant after hepatectomy in rats

2014 ◽  
Vol 41 (3) ◽  
pp. 198-202 ◽  
Author(s):  
Tâmara Rúbia Cavalcante Guimarães Coutinho ◽  
Osvaldo Malafaia ◽  
Orlando Jorge Martins Torres ◽  
Jurandir Marcondes Ribas Filho ◽  
Alvaro Fonseca Kaminski ◽  
...  
Keyword(s):  
Hepatic Resection ◽  
Fibrin Sealant ◽  
Laboratory Tests ◽  
Wistar Rats ◽  
Histological Analysis ◽  
Liver Enzymes ◽  
Statistical Significance ◽  
Polymorphonuclear Cells ◽  
The Third ◽  
Elevated Liver Enzymes

OBJECTIVE: To compare between electrocautery and fibrin sealant hemostasis in rats after partial hepatectomy. METHODS: we used 24 Wistar rats, which were submitted to 30% hepatic resection, divided into two groups of 12 animals each: Group Electrocautery and Group Tachosil(r). These animals were evaluated after three and 14 days. We assessed the presence of complications, laboratory tests and histological exam of the recovered liver. RESULTS: the presence of abscess was more prevalent in the electrocautery group. The observed adhesions were more pronounced in the electrocautery group, both in frequency and in intensity, after three and 14 days. There were no deaths in either group. As for laboratory analysis, after three days the hematocrit was lower in the TachoSil(r) Group. The elevation of AST and ALT were more pronounced in the electrocautery group (p = 0.002 and p = 0.004) in three days. Histological analysis of specimens collected on the third day after surgery showed similar results in both groups for the presence of polymorphonuclear cells, whereas mononuclear was more evident in the TachoSil(r) group. We also observed that angiogenesis, although present in both groups, was more pronounced in the TachoSil(r) group (p = 0.030). However, on the 14th day angiogenesis was more pronounced in the electrocautery group, but without statistical significance. CONCLUSION: hemostasis achieved by the groups was similar; however, the use of electrocautery was associated with infections, adhesions at higher grades and elevated liver enzymes.

scholarly journals A clinical study of viral hepatitis in children: a prospective hospital-based study

2018 ◽  
Vol 5 (2) ◽  
pp. 563
Author(s):  
Girish N. ◽  
Sunil B. ◽  
Ranganatha A. Devaranavadagi
Keyword(s):  
Viral Hepatitis ◽  
Hepatitis A ◽  
Total Bilirubin ◽  
Clinical Presentation ◽  
Liver Enzymes ◽  
Public Health Issue ◽  
Paediatric Unit ◽  
Elevated Liver Enzymes ◽  
Laboratory Investigations ◽  
Almost All

Background: Viral hepatitis is a major public health issue throughout the world affecting millions of children; Clinical presentation may vary from asymptomatic to hepatitis, cirrhosis, liver failure and cancer. This study is aimed at understanding the clinical profile of viral hepatitis in children.Methods: Prospectively, 48 children admitted in paediatric unit with confirmed viral hepatitis from August 2015 to July 2016 at KIMS hospital, Bangalore were included. In each case, age, sex, clinical presentation and laboratory investigations were collected and analysed.Results: Out of 48 patients, 26 were girls and 22 were boys. Out of which 40 cases were positive for IgM Hepatitis A, 1 case of HbsAg positive, 7 cases were non-A non B Hepatitis. All cases presented with fever (100%), jaundice found in 40 cases (83.3%), 33 cases had abdominal pain (68.7%), vomiting was present in 40 cases (83.7%), 34 cases presented with dark colored urine (70.8%), altered sensorium in 3 cases (6.2%). Icterus was found in 48 (100%) cases, pallor was found in 17 cases (35.4%), Ascitis in 8 cases (16.7%), hepatomegaly in 37 cases (76%), oedema in 10 cases (21%). Liver enzymes elevated at admission in almost all cases, 16 cases had SGPT b/w 200-500. 10 cases had SGPT b/w 500-1000, 19 cases had SGPT b/w 1000-3000 and 2 cases had SGPT of more than 3000. 18 cases had total bilirubin between 5-10 mg/dl, 6 cases had total bilirubin >10 mg/dl. 44 cases had PT <1.5 at admission, 1 case had PT INR between 1.5-2.5, 1 case had INR between 2.5-3.5, 2 cases had INR>3.5. Out of 48 cases 2 cases died. Out of 2 deaths, 1 case of hepatitis A and 1 case positive for Hepatitis B. The cause of death was hepatic encephalopathy in both the cases.Conclusions: Majority of cases in children were hepatitis A cases, followed by non-A non B. Most of the cases were aged above 3 years with slight girl’s predominance. Those cases with elevated liver enzymes (SGOT >3000) and those with PT INR >3 at admission has higher mortality.

Twin-to-twin transfusion syndrome as a cause of neonatal acute liver failure

2020 ◽  
Vol 13 (4) ◽  
pp. 163-170
Author(s):  
Chattip Prueksapraopong ◽  
Varisa Piriyakitpaiboon ◽  
Dissajee Lumbiganon
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Neonatal Intensive Care ◽  
Liver Enzymes ◽  
Clinical Symptoms ◽  
Rare Condition ◽  
International Normalized Ratio ◽  
Adverse Outcomes ◽  
Elevated Liver Enzymes ◽  
Possible Cause

AbstractBackgroundAcute liver failure (ALF) is a rare condition during neonatal period.ObjectiveTo report a case of recipient twin with fulminant ALF secondary to hydrops fetalis caused by twin-to-twin transfusion syndrome (TTTS).MethodThe patient was admitted to the neonatal intensive care unit (NICU) for respiratory failure requiring mechanical ventilation and fulminant ALF with prolonged international normalized ratio (INR) and elevated liver enzymes with highest aspartate aminotransferase of 4,580 U/L.ResultsLaboratory investigation for secondary causes of liver failure was not revealing. Her liver enzymes and coagulation levels were dramatically normalized as the clinical symptoms of hypervolemia improved within 1 week.ConclusionTTTS can be a possible cause of neonatal ALF. Early detection with proper management of TTTS is important to avoid adverse outcomes. However, pathogenesis of hepatic dysfunction in TTTS is rarely described, and further studies are needed to help understanding the correlation between liver diseases and TTTS.

Hepatitis A Antigen in Liver, Bile and Stool

1975 ◽  
Vol 33 ◽  
pp. 340-341
Author(s):  
D.R. Jackson ◽  
J.H. Hoofnagle ◽  
A.N. Schulman ◽  
J.L. Dienstag ◽  
R.H. Purcell ◽  
...  
Keyword(s):  
Hepatitis A ◽  
Liver Enzymes ◽  
Hepatitis A Virus ◽  
Type A ◽  
Initial Study ◽  
Virus Like Particle ◽  
Elevated Liver Enzymes ◽  
Ag Particles ◽  
Ag Particle ◽  
Human Stool

Using immune electron microscopy Feinstone et. al. demonstrated the presence of a 27 nm virus-like particle in acute-phase stools of patients with viral hepatitis, type A, These hepatitis A antigen (HA Ag) particles were aggregated by convalescent serum from patients with type A hepatitis but not by pre-infection serum. Subsequently Dienstag et. al. and Maynard et. al. produced acute hepatitis in chimpanzees by inoculation with human stool containing HA Ag. During the early acute disease, virus like particles antigenically, morphologically and biophysically identical to the human HA Ag particle were found in chimpanzee stool. Recently Hilleman et. al. have described similar particles in liver and serum of marmosets infected with hepatitis A virus (HAV). We have investigated liver, bile and stool from chimpanzees and marmosets experimentally infected with HAV. In an initial study, a chimpanzee (no.785) inoculated with HA Ag-containing stool developed elevated liver enzymes 21 days after exposure.

Differential diagnosis of elevated liver enzymes: case reports

2008 ◽  
Vol 46 (05) ◽  
Author(s):  
T Korom ◽  
I Nagy ◽  
É Csajbók ◽  
T Wittmann
Keyword(s):  
Differential Diagnosis ◽  
Liver Enzymes ◽  
Case Reports ◽  
Elevated Liver Enzymes
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