Possible ciprofloxacin-induced acute cholestatic jaundice

OBJECTIVE: To report a case of acute cholestatic jaundice in a patient who was receiving oral ciprofloxacin. CASE SUMMARY: An 84-year-old woman residing in a long-term care facility developed acute cholestatic jaundice while being treated with ciprofloxacin for a urinary tract infection. On day 6 of ciprofloxacin therapy, she was noted to have an erythematous, pruritic rash over her chest and abdomen. At this point ciprofloxacin treatment was discontinued, as an allergy was suspected. Three days later she was noted to have jaundiced sclera and skin, and liver function test results were markedly elevated. The plasma cholesterol concentration was increased substantially; there was no decrease in plasma albumin concentration or increase in prothrombin time. The patient was treated with intravenous fluids. Within the next month, the liver function test results decreased to near normal and the patient was asymptomatic. Follow-up liver test results three months later were normal. DISCUSSION: To our knowledge, there are only a few other case reports in the literature of a possible ciprofloxacin-induced liver injury. Enoxacin, a fluorinated quinolone antibiotic similar to ciprofloxacin, was reported to cause cholestatic liver injury in one patient. The exact mechanism by which fluoroquinolones may cause liver injury is unknown. CONCLUSIONS: We believe that this is only the second reported case of acute cholestatic jaundice resulting from ciprofloxacin therapy. Although this reaction seems to occur rarely, it is prudent to be alert for the signs and symptoms of cholestasis when administering ciprofloxacin.