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Daptomycin-Induced Acute Renal and Hepatic Toxicity Without Rhabdomyolysis

Clinical Associate Professor of Medicine, Department of Medicine, Saint Vincent Hospital, Worcester, MA

Dmitry Finkelberg, MD

Fellow in Gastroenterology, University of Massachusetts Medical Center, Worcester

Linda M Spooner, PharmD BCPS

Assistant Professor of Pharmacy Practice, Department of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences School of Pharmacy-Worcester/Manchester,Worcester

Reprints: Dr. Spooner, Department of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences, School of Pharmacy-Worcester/Manchester, 19 Foster St., Worcester, MA, fax 508/756-8715, linda.spooner{at}mcphs.edu

OBJECTIVE: To report a case of a patient who experienced acute renal and hepatic toxicity following administration of daptomycin and review previously published case reports of renal and hepatic dysfunction with daptomycin.

CASE SUMMARY: A 35-year-old man receiving daptomycin 4 mg/kg (275 mg) intravenously once daily (started 5 wk prior to presentation for presumed osteomyelitis) presented to the emergency department with elevations in serum creatinine and hepatic transaminase levels. He did not experience creatine kinase (CK) elevation or rhabdomyolysis. Following discontinuation of daptomycin, his renal and hepatic function improved.

DISCUSSION: To our knowledge, this is the first case of daptomycin-induced hepatotoxicity with acute renal failure in the absence of rhabdomyolysis and CK abnormalities. Previously published case reports described patients with a variety of elevations in liver function tests, serum creatinine, and CK with daptomycin. In our patient, the acute renal and hepatic toxicity was probable according to the Naranjo probability scale.

CONCLUSIONS: Although daptomycin is a well-tolerated antibacterial agent, clinicians should consider periodic monitoring of liver function and renal function tests to identify potential adverse effects.

Key Words: acute renal failure, daptomycin, hepatotoxicity

Published Online, April 1, 2008. www.theannals.com, DOI 10.1345/aph.1K579