title: Azithromycin-induced liver injury.
abstract: OBJECTIVE
  A case of azithromycin-induced hepatotoxicity in a 69-year-old woman with no history of liver disease is reported.
  
  
  CONCLUSIONS
  After receiving four days of high-dose azithromycin for the treatment of suspected bronchitis, a 69-year-old woman arrived at the emergency room with nausea, vomiting, diarrhea, elevated liver enzyme values, and visible signs of pruritus and jaundice. Her medical history included hypertension, hypothyroidism secondary to Graves disease, depression, dyslipidemia, and chronic obstructive pulmonary disease. She had no history of liver, cardiac, genitourinary, and renal diseases. Causes of primary liver injury, including metabolic, viral, and autoimmune liver diseases, were excluded. Her International Normalized Ratio was elevated, and substantial transaminitis was noted. There was no evidence of portal vein thrombosis on ultrasound, and extrahepatic obstruction was unlikely. Liver injury associated with right heart failure was unlikely, as right ventricular function was relatively preserved and right atrial pressure was not severely elevated. Ischemic hepatitis was also ruled out. After exclusion of other causes of liver disease, drug-induced hepatotoxicity was considered. A careful review of her medications prior to admission was conducted. A temporal relationship between initiation of azithromycin and the onset of clinical signs and symptoms was noted. The Naranjo et al. probability scale indicated a possible relationship between azithromycin and hepatotoxicity; however, two scales specifically used for evaluating drug-induced liver disease indicated a probable adverse drug-associated event.
  
  
  CONCLUSIONS
  A 69-year-old woman developed cholestatic hepatitis after four days of therapy with high-dose azithromycin for the treatment of suspected bronchitis.
authors.affiliation: Department of Pharmacy and Drug Information, Parkland Health and Hospital System, Dallas, TX 75235, USA. alissalockwood@yahoo.com
authors.forename: Alissa M
authors.initials: AM
authors.lastname: Lockwood
authors.forename: Sabrina
authors.initials: S
authors.lastname: Cole
authors.forename: Marina
authors.initials: M
authors.lastname: Rabinovich
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D017963:Azithromycin / Q000009:adverse effects*; D001991:Bronchitis / Q000188:drug therapy*; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008111:Liver Function Tests / Q000706:statistics & numerical data
chemical_list: D000900:Anti-Bacterial Agents; D017963:Azithromycin