title: Drug-induced hepatocellular liver injury due to benzylpenicillin with evidence of lymphocyte sensitization.
abstract: OBJECTIVE
  Reports on drug-induced liver injury due to benzylpenicillin are scarce and predominantly describe cases of intrahepatic cholestasis. To our knowledge, no immunologically documented case of hepatocellular liver injury due to benzylpenicillin has been reported so far.
  
  
  METHODS
  A previously healthy man required long-term therapy with benzylpenicillin because of vertebral spondylitis. After 4 weeks of treatment, liver tests showed a marked increase in transaminases associated with high peripheral eosinophil counts. Discontinuation of benzylpenicillin resulted in gradual recovery.
  
  
  METHODS
  Levels of eosinophil cationic protein were elevated, indicating eosinophil activation and the presence of an immunoallergic reaction. Skin tests and assays for specific Ig E-antibodies to benzylpenicillin were negative, but lymphocyte transformation tests demonstrated T-cell sensitization to benzylpenicillin.
  
  
  CONCLUSIONS
  According to current causality assessment schemes, our report constitutes a probable case of drug-induced hepatocellular liver injury due to benzylpenicillin.
authors.affiliation: Department of Internal Medicine, University Hospital, Basel, Switzerland.
authors.forename: T M
authors.initials: TM
authors.lastname: Bauer
authors.forename: A J
authors.initials: AJ
authors.lastname: Bircher
mesh_terms: D006801:Humans; D008099:Liver / Q000187:drug effects* / Q000473:pathology; D008213:Lymphocyte Activation / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D010400:Penicillin G / Q000009:adverse effects*; D010406:Penicillins / Q000009:adverse effects*; D013601:T-Lymphocytes / Q000187:drug effects* / Q000276:immunology
chemical_list: D010406:Penicillins; D010400:Penicillin G