Fulminant liver failure associated with clarithromycin.
OBJECTIVE
To report a patient developing fulminant liver failure while being treated with clarithromycin for pneumonia.


METHODS
A 58-year-old white woman developed fulminant liver failure while being treated with the macrolide antibiotic clarithromycin for pneumonia. Comedication included N-acetylcysteine, atenolol, and isradipine. Other causes of liver failure, such as viral hepatitis, autoimmune hepatitis, toxins, and heart failure, were excluded by appropriate diagnostic means. All drugs were stopped, and the patient was transferred to another hospital for liver transplantation. She recovered spontaneously within several days, making transplantation unnecessary. A liver biopsy obtained 10 days after the initial presentation revealed centroacinar necrosis and beginning fibrous reorganization, compatible with recent centroacinar damage.


CONCLUSIONS
Since no other cause could be identified, liver injury was considered to be drug related. Fulminant liver failure has not previously been described with concomitant use of atenolol and N-acetylcysteine. Although isradipine has been associated with hepatocellular injury, there are no reports of fulminant liver failure with this agent, and our patient had been treated for >2 years without signs of toxicity. The most likely cause of liver failure in this patient was, therefore, clarithromycin, which undergoes hepatic metabolism and has been reported to cause fulminant hepatic failure. A second possibility is an interaction between clarithromycin and isradipine, potentially increasing the hepatic toxicity of isradipine.


CONCLUSIONS
Clarithromycin may be a cause of fulminant liver failure either alone or by inhibiting the metabolism of other drugs.
Tietz
Andreas
A
Department of Internal Medicine, University Hospital, Basel, Switzerland.
Heim
Markus H
MH
Eriksson
Urs
U
Marsch
Stephan
S
Terracciano
Luigi
L
Krähenbühl
Stephan
S
D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D017291:Clarithromycin / Q000009:adverse effects*; D005260:Female; D006801:Humans; D017093:Liver Failure / Q000139:chemically induced*; D008111:Liver Function Tests; D008875:Middle Aged; D011014:Pneumonia / Q000188:drug therapy
D000900:Anti-Bacterial Agents; D017291:Clarithromycin