title: Multiple organ toxicity from addition of erythromycin to long-term lovastatin therapy.
abstract: A patient who had taken lovastatin for 7 years received erythromycin before dental procedures. Multiple organ toxicity developed, manifested as rhabdomyolysis, acute renal failure, pancreatitis, ileus, livedo reticularis, and elevated aminotransferase values, without liver injury. No previous reports have identified multiple organ injury of this magnitude. A computer literature search identified only three other reported instances of erythromycin and lovastatin interaction. Manifestations in these previous cases consisted of rhabdomyolysis in all three, as well as elevated aminotransferase values and acute renal failure in two cases. In all the cases, the clinical presentation of organ toxicity occurred after the cessation of erythromycin therapy between day 1 and day 5. Advanced age and chronic renal insufficiency were identified as potential risk factors for drug interaction. Health care professionals should be aware of the potential interaction between these two commonly prescribed drugs, which can mimic sepsis.
authors.affiliation: Gastroenterology Service, Brooke Army Medical Center, San Antonio, Tex 78234, USA.
authors.forename: P W
authors.initials: PW
authors.lastname: Wong
authors.forename: T A
authors.initials: TA
authors.lastname: Dillard
authors.forename: K
authors.initials: K
authors.lastname: Kroenke
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D000924:Anticholesteremic Agents / Q000009:adverse effects*; D001219:Aspartate Aminotransferases / Q000097:blood; D004347:Drug Interactions; D004917:Erythromycin / Q000009:adverse effects*; D006801:Humans; D007415:Intestinal Obstruction / Q000139:chemically induced; D008148:Lovastatin / Q000009:adverse effects*; D008297:Male; D010195:Pancreatitis / Q000139:chemically induced; D012206:Rhabdomyolysis / Q000139:chemically induced; D017445:Skin Diseases, Vascular / Q000139:chemically induced
chemical_list: D000900:Anti-Bacterial Agents; D000924:Anticholesteremic Agents; D004917:Erythromycin; D008148:Lovastatin; D001219:Aspartate Aminotransferases