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Progressive Cholestatic Liver Disease Associated with Clarithromycin Treatment
Author(s) -
Fox Jean C.,
Szyjkowski Ronald S.,
Sanderson Schuyler O.,
Levine Robert A.
Publication year - 2002
Publication title -
the journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.92
H-Index - 116
eISSN - 1552-4604
pISSN - 0091-2700
DOI - 10.1177/00970002042006011
Subject(s) - medicine , clarithromycin , jaundice , gastroenterology , cholestasis , liver biopsy , autopsy , hemodialysis , dialysis , diabetes mellitus , surgery , biopsy , helicobacter pylori , endocrinology
The authors report a case of an acute toxic cholestatic reaction to clarithromycin, proven by liver biopsy, in a patient with comorbid diseases, prior exposure to erythromycin and ultimate death. No autopsy was performed. A 59‐year‐old woman with diabetes mellitus and chronic renal insufficiency received clarithromycin 500 mg twice daily for 3 days for acute maxillary sinusitis and then developed a rash and jaundice. She was hospitalized 11 days after stopping clarithromycin. Progressive cholestatic jaundice accompanied by oligo‐anuric renal failure requiring hemodialysis ensued. Liver biopsy showed pure bilirubinostasis without parenchymal inflammation. On the 22nd hospital day, after clinical deterioration, she died from an apparent cardiopulmonary death. This is the first report in the literature of a fatality associated with a short‐term, low (1 g) daily dose of drug‐induced pure cholestasis, an entity not previously identified with severe drug‐induced hepatotoxicity