title: [Clinical case of the month. Cholestatic hepatitis after administration of piperacillin].
abstract: We describe a patient suffering from infection of the upper respiratory tract, who was treated with a dose of 4 x 4 g of piperacillin over 10 days. Two days after the end of the treatment, she developed jaundice and had elevated alkaline phosphatase, gammaglutamyltransferase and transaminases. After exclusion of viral hepatitis, a vascular problem, and gall stone disease, the possibility of piperacillin-induced hepatitis was discussed. Lymphocyte transformation test for piperacillin was positive, suggesting an immunological mechanism for the observed hepatopathy. The patient was discharged a few days after in good clinical condition and with reduced liver values. Cholestasis gradually decreased but was detectable for several weeks. The patient had a full clinical and biochemical recovery after 2 months. We conclude that short-term therapy with piperacillin can lead to the same type of hepatopathy as described for amoxycillin/clavulanic acid or antistaphylococcal penicillins. Positive lymphocyte transformation is compatible with an immunological mechanism.
authors.affiliation: Service de Gastroentérologie, Clinique Saint Joseph, Liège.
authors.forename: M A
authors.initials: MA
authors.lastname: Dietze
authors.forename: P
authors.initials: P
authors.lastname: Martin
authors.forename: N
authors.initials: N
authors.lastname: Schaaf-Lafontaine
mesh_terms: D056486:Chemical and Drug Induced Liver Injury / Q000473:pathology*; D002779:Cholestasis / Q000139:chemically induced*; D005260:Female; D006801:Humans; D008213:Lymphocyte Activation; D008875:Middle Aged; D010406:Penicillins / Q000009:adverse effects* / Q000627:therapeutic use; D010878:Piperacillin / Q000009:adverse effects* / Q000627:therapeutic use; D012141:Respiratory Tract Infections / Q000188:drug therapy
chemical_list: D010406:Penicillins; D010878:Piperacillin