Terbinafine hepatotoxicity. A case report and review of literature.
We report a 53-year old Mexican female who developed liver dysfunction following a seven-day course of treatment with terbinafine for onychomycosis. She presented with jaundice and abdominal pain. Her serum bilirubin levels showed a peak value of 23.2 mg/dL seven weeks after discontinuing the medication. Infectious causes (hepatitis viruses A, B and C) were excluded. Imaging studies of the abdomen did not reveal any abnormalities. Serum iron and ceruloplasmin levels were normal. Autoantibodies were negative. A liver biopsy revealed necrosis and mononuclear infiltration of the parenchyma, mainly along the sinusoids and surrounding the portal spaces and biliary ducts. Eosinophil infiltration of the portal spaces was also noted. Treatment with ursodeoxycholic acid and ademethionine was started. Her liver tests normalized in the sixth months after stopping terbinafine.
Zapata Garrido
Alfonso Javier
AJ
Hospital Christus Muguerza, Monterrey, Nuevo León, Mexico.
Romo
Alberto Casillas
AC
Padilla
Francisco Bosques
FB
D000935:Antifungal Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002756:Cholagogues and Choleretics / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007565:Jaundice / Q000139:chemically induced / Q000188:drug therapy; D008099:Liver / Q000473:pathology*; D017114:Liver Failure, Acute / Q000139:chemically induced* / Q000188:drug therapy / Q000473:pathology; D008111:Liver Function Tests; D008875:Middle Aged; D009281:Naphthalenes / Q000009:adverse effects* / Q000627:therapeutic use; D014009:Onychomycosis / Q000188:drug therapy*; D000077291:Terbinafine; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
D000935:Antifungal Agents; D002756:Cholagogues and Choleretics; D009281:Naphthalenes; D014580:Ursodeoxycholic Acid; D000077291:Terbinafine