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• W3208227178 abstract "Introduction: Drug-induced Liver Injury (DILI) is an important cause of acute liver failure cases in the United States. The diagnosis of DILI requires a high index of suspicion after diligently excluding other causes of abnormal liver tests. Antibiotics are the class of drugs most frequently associated with idiosyncratic DILI. We present a case of acute liver failure secondary to doxycycline induced liver injury. Case Description/Methods: A 71-year-old female with bullous pemphigoid treated with doxycycline was admitted for nausea and vomiting. Symptoms were presumed to be secondary to medication-induced esophagitis. Her symptoms improved with discontinuation of the medication. One week into her hospitalization, she developed acute liver failure. Her serum liver enzymes were elevated. AST and direct bilirubin were elevated to 10 times the upper limit of normal (ULN). ALT was elevated to three times the ULN. Alkaline phosphatase was normal. She was coagulopathic with INR of 5.1 and thrombocytopenic with a platelet count of 49. She was also mildly confused with hypersomnia consistent with grade I hepatic encephalopathy. She had jaundice and icterus. Initial work up including viral hepatitis serologies, cytomegalovirus (CMV), Epstein Barr virus, autoimmune markers, ceruloplasmin, iron studies including ferritin, liver ultrasound and computed tomography of the abdomen were all unremarkable. There was concern for drug-induced liver injury as the patient had been taking doxycycline 100 mg every 12 hours for her bullous pemphigoid for at least two weeks prior to her hospitalization. She underwent a liver biopsy that showed cholestatic liver injury with ductular reaction and hepatocellular dropout/collapse. Given her clinical history, the composite histologic finding was consistent with drug/toxin-induced hepatocellular injury. She remained jaundiced at the time of discharge, but her liver tests were starting to improve. Discussion: Of all known liver diseases, the diagnosis of DILI is probably one of the most difficult one to establish. Doxycycline is not commonly associated with DILI. There are only a few case reports of doxycycline induced liver injury. There are also no published case reports of acute liver failure caused by doxycycline. This case highlights that although doxycycline is considered a safe antibiotic, it can cause acute liver failure and a high degree of suspicion is required if you are suspecting doxycycline induced liver injury.Figure 1.: Drug Induced Liver Injury Secondary to Doxycycline.Table 1.: Laboratory Values (table format was adapted from LiverTox)." @default.
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• W3208227178 date "2021-10-01" @default.
• W3208227178 modified "2023-10-02" @default.
• W3208227178 title "S2916 Acute Liver Failure Secondary to Doxycycline Induced Liver Injury" @default.
• W3208227178 doi "https://doi.org/10.14309/01.ajg.0000785196.70774.41" @default.
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