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Levofloxacin-Induced Acute Fulminant Hepatic Failure in a Patient with Chronic Hepatitis B Infection

ahin Çoban, MD¹, Bilge Ceydilek, MD², Fuat Ekiz, MD³, Esra Erden, MD⁴, and rfan Soykan, MD⁵

¹ Specialist, Department of Gastroenterology, Ankara University Medical School, Ankara, Turkey
² Research Fellow, Department of Gastroenterology, Ankara University Medical School
³ Research Fellow, Department of Gastroenterology, Ankara University Medical School
⁴ Professor, Department of Pathology, Ankara University Medical School
⁵ Professor, Department of Gastroenterology, Ankara University Medical School

Reprints: Dr. Çoban, Department of Gastroenterology, Ankara University Medical School, 06100, Cebeci, Ankara, Turkey, fax 90 312 310 63 71, scoban72{at}yahoo.com

OBJECTIVE: To report a case of possible levofloxacin-induced acute fulminant hepatic failure.

CASE SUMMARY: An unconscious 55-year-old woman was hospitalized with the diagnosis of hepatic encephalopathy. The patient had received levofloxacin 500 mg daily for 10 days because of an upper respiratory infection. Her past medical history revealed hepatitis B surface antigen positivity as an asymptomatic hepatitis B virus carrier for 10 years. After hospitalization, treatment included plasmapheresis and supportive care. The patient's consciousness improved on the second day of treatment. Other etiologies of fulminant hepatic failure were ruled out, suggesting levofloxacin-induced fulminant hepatic failure. Although the patient received supportive treatment, her condition gradually deteriorated and she died 12 weeks after admission to our hospital. An objective causality assessment revealed that the adverse event was possibly related to levofloxacin.

DISCUSSION: Levofloxacin is widely used because of its broad spectrum of antimicrobial activity. As of August 9, 2005, to our knowledge, only one case of fulminant hepatic failure in relation to levofloxacin has previously been published. We believe that, in our patient, the relationship between levofloxacin and her illness is clear because of the negative results in the etiological studies, the short time between the drug's administration and the development of disease, and the pathologic findings suggestive of drug-induced hepatitis.

CONCLUSIONS: Clinicians should be aware of the possibility of severe hepatic injury associated with levofloxacin when prescribing this drug.

Key Words: hepatic failure, levofloxacin

Published Online, August 16, 2005. www.theannals.com, DOI 10.1345/aph.1G111