Clarithromycin-Associated Acute Liver Failure Leading to Fatal, Massive Upper Gastrointestinal Hemorrhage from Profound Coagulopathy: Case Report and Systematic Literature Review
While erythromycin has caused numerous cases of acute liver failure (ALF), clarithromycin, a similar macrolide antibiotic, has caused only six reported cases of ALF. A new case of clarithromycin-associated ALF is reported with hepatic histopathology and exclusion of other etiologies by extensive wor...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2020-01-01
|
| Series: | Case Reports in Hepatology |
| Online Access: | http://dx.doi.org/10.1155/2020/2135239 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832550449790582784 |
|---|---|
| author | Ahmed I. Edhi Seifeldin Hakim Christienne Shams Damanpreet Bedi Mitual Amin Mitchell S. Cappell |
| author_facet | Ahmed I. Edhi Seifeldin Hakim Christienne Shams Damanpreet Bedi Mitual Amin Mitchell S. Cappell |
| author_sort | Ahmed I. Edhi |
| collection | DOAJ |
| description | While erythromycin has caused numerous cases of acute liver failure (ALF), clarithromycin, a similar macrolide antibiotic, has caused only six reported cases of ALF. A new case of clarithromycin-associated ALF is reported with hepatic histopathology and exclusion of other etiologies by extensive workup, and the syndrome of clarithromycin-associated ALF is better characterized by systematic review. A 60-year-old nonalcoholic man, with normal baseline liver function tests, was admitted with diffuse abdominal pain and AST = 499 U/L and ALT = 539 U/L, six days after completing a 7-day course of clarithromycin 500 mg twice daily for suspected upper respiratory infection. AST and ALT each rose to about 1,000 U/L on day-2 of admission, and rose to ≥6,000 U/L on day-3, with development of severe hepatic encephalopathy and severe coagulopathy. Planned liver biopsy was cancelled due to coagulopathies. Extensive evaluation for infectious, immunologic, and metabolic causes of liver disease was negative. Abdominal computerized tomography and abdominal ultrasound with Doppler were unremarkable. The patient developed massive, acute upper gastrointestinal bleeding associated with coagulopathies. Esophagogastroduodenoscopy was planned after massive blood product transfusions, but the patient rapidly expired from hemorrhagic shock. Autopsy revealed a golden-brown heavy liver with massive hepatic necrosis and sinusoidal congestion. Rise of AST/ALT to about 1,000 U/L each was temporally incompatible with shock liver because this rise preceded the hemorrhagic shock, but the subsequent AST/ALT rise to ≥6,000 U/L each may have had a component of shock liver. The six previously reported cases were limited by failure to exclude hepatitis E (4), lack of liver biopsy (2), and uninterpretable liver biopsy (1) and by confounding potential etiologies including disulfiram, israpidine, or recent acetaminophen use (3), clarithromycin overdose (1), active alcohol use (1), and severe heart failure (1). Review of 6 previously reported and current case of clarithromycin-associated ALF revealed that patients had AST and ALT values in the thousands. Five patients died and 2 survived. |
| format | Article |
| id | doaj-art-ceb9690b99fe458980023fef45e03c9f |
| institution | Kabale University |
| issn | 2090-6587 2090-6595 |
| language | English |
| publishDate | 2020-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Hepatology |
| spelling | doaj-art-ceb9690b99fe458980023fef45e03c9f2025-02-03T06:06:43ZengWileyCase Reports in Hepatology2090-65872090-65952020-01-01202010.1155/2020/21352392135239Clarithromycin-Associated Acute Liver Failure Leading to Fatal, Massive Upper Gastrointestinal Hemorrhage from Profound Coagulopathy: Case Report and Systematic Literature ReviewAhmed I. Edhi0Seifeldin Hakim1Christienne Shams2Damanpreet Bedi3Mitual Amin4Mitchell S. Cappell5Division of Gastroenterology & Hepatology, Department of Medicine, William Beaumont Hospital, 3535 W Thirteen Mile Rd, Royal Oak, MI 48073, USADivision of Gastroenterology & Hepatology, Department of Medicine, William Beaumont Hospital, 3535 W Thirteen Mile Rd, Royal Oak, MI 48073, USADepartment of Medicine, William Beaumont Hospital, Oakland University William Beaumont School of Medicine, 3535 W Thirteen Mile Rd, Royal Oak, MI 48073, USATransplant Surgery, Department of Surgery, William Beaumont School of Medicine, 3601 W Thirteen Mile Rd, Royal Oak, MI 48073, USADepartment of Pathology, William Beaumont Hospital, Oakland University William Beaumont School of Medicine, 3601 W Thirteen Mile Rd, Royal Oak, MI 48073, USADivision of Gastroenterology & Hepatology, Department of Medicine, William Beaumont Hospital, 3535 W Thirteen Mile Rd, Royal Oak, MI 48073, USAWhile erythromycin has caused numerous cases of acute liver failure (ALF), clarithromycin, a similar macrolide antibiotic, has caused only six reported cases of ALF. A new case of clarithromycin-associated ALF is reported with hepatic histopathology and exclusion of other etiologies by extensive workup, and the syndrome of clarithromycin-associated ALF is better characterized by systematic review. A 60-year-old nonalcoholic man, with normal baseline liver function tests, was admitted with diffuse abdominal pain and AST = 499 U/L and ALT = 539 U/L, six days after completing a 7-day course of clarithromycin 500 mg twice daily for suspected upper respiratory infection. AST and ALT each rose to about 1,000 U/L on day-2 of admission, and rose to ≥6,000 U/L on day-3, with development of severe hepatic encephalopathy and severe coagulopathy. Planned liver biopsy was cancelled due to coagulopathies. Extensive evaluation for infectious, immunologic, and metabolic causes of liver disease was negative. Abdominal computerized tomography and abdominal ultrasound with Doppler were unremarkable. The patient developed massive, acute upper gastrointestinal bleeding associated with coagulopathies. Esophagogastroduodenoscopy was planned after massive blood product transfusions, but the patient rapidly expired from hemorrhagic shock. Autopsy revealed a golden-brown heavy liver with massive hepatic necrosis and sinusoidal congestion. Rise of AST/ALT to about 1,000 U/L each was temporally incompatible with shock liver because this rise preceded the hemorrhagic shock, but the subsequent AST/ALT rise to ≥6,000 U/L each may have had a component of shock liver. The six previously reported cases were limited by failure to exclude hepatitis E (4), lack of liver biopsy (2), and uninterpretable liver biopsy (1) and by confounding potential etiologies including disulfiram, israpidine, or recent acetaminophen use (3), clarithromycin overdose (1), active alcohol use (1), and severe heart failure (1). Review of 6 previously reported and current case of clarithromycin-associated ALF revealed that patients had AST and ALT values in the thousands. Five patients died and 2 survived.http://dx.doi.org/10.1155/2020/2135239 |
| spellingShingle | Ahmed I. Edhi Seifeldin Hakim Christienne Shams Damanpreet Bedi Mitual Amin Mitchell S. Cappell Clarithromycin-Associated Acute Liver Failure Leading to Fatal, Massive Upper Gastrointestinal Hemorrhage from Profound Coagulopathy: Case Report and Systematic Literature Review Case Reports in Hepatology |
| title | Clarithromycin-Associated Acute Liver Failure Leading to Fatal, Massive Upper Gastrointestinal Hemorrhage from Profound Coagulopathy: Case Report and Systematic Literature Review |
| title_full | Clarithromycin-Associated Acute Liver Failure Leading to Fatal, Massive Upper Gastrointestinal Hemorrhage from Profound Coagulopathy: Case Report and Systematic Literature Review |
| title_fullStr | Clarithromycin-Associated Acute Liver Failure Leading to Fatal, Massive Upper Gastrointestinal Hemorrhage from Profound Coagulopathy: Case Report and Systematic Literature Review |
| title_full_unstemmed | Clarithromycin-Associated Acute Liver Failure Leading to Fatal, Massive Upper Gastrointestinal Hemorrhage from Profound Coagulopathy: Case Report and Systematic Literature Review |
| title_short | Clarithromycin-Associated Acute Liver Failure Leading to Fatal, Massive Upper Gastrointestinal Hemorrhage from Profound Coagulopathy: Case Report and Systematic Literature Review |
| title_sort | clarithromycin associated acute liver failure leading to fatal massive upper gastrointestinal hemorrhage from profound coagulopathy case report and systematic literature review |
| url | http://dx.doi.org/10.1155/2020/2135239 |
| work_keys_str_mv | AT ahmediedhi clarithromycinassociatedacuteliverfailureleadingtofatalmassiveuppergastrointestinalhemorrhagefromprofoundcoagulopathycasereportandsystematicliteraturereview AT seifeldinhakim clarithromycinassociatedacuteliverfailureleadingtofatalmassiveuppergastrointestinalhemorrhagefromprofoundcoagulopathycasereportandsystematicliteraturereview AT christienneshams clarithromycinassociatedacuteliverfailureleadingtofatalmassiveuppergastrointestinalhemorrhagefromprofoundcoagulopathycasereportandsystematicliteraturereview AT damanpreetbedi clarithromycinassociatedacuteliverfailureleadingtofatalmassiveuppergastrointestinalhemorrhagefromprofoundcoagulopathycasereportandsystematicliteraturereview AT mitualamin clarithromycinassociatedacuteliverfailureleadingtofatalmassiveuppergastrointestinalhemorrhagefromprofoundcoagulopathycasereportandsystematicliteraturereview AT mitchellscappell clarithromycinassociatedacuteliverfailureleadingtofatalmassiveuppergastrointestinalhemorrhagefromprofoundcoagulopathycasereportandsystematicliteraturereview |