title: Amoxicillin/clavulanic acid-induced cholestatic liver injury after pediatric liver transplantation.
abstract: BACKGROUND
  Amoxicillin/clavulanic acid-induced liver injury is a well recognized complication. Presentation and outcome may vary, which is related to individual liver maturity, genetic predisposition, enzyme heterogeneity, intensity of treatment, and drug interactions. In most cases withdrawing the drug is sufficient treatment; however, cases of progressive liver damage leading to liver transplantation have been reported.
  
  
  METHODS
  We present the case of an 8-year-old patient after liver transplantation who developed drug induced liver injury (DILI) after amoxicillin/clavulanic acid treatment for upper respiratory tract infection. Jaundice appeared 2 days after cessation of treatment. Clinical presentation and liver biopsy were consistent with DILI. Because of rapidly increasing bilirubin levels, we used 3 boluses of methylprednisolone and ursodeoxycholic acid. The treatment reversed progression of the cholestasis and full recovery was achieved in 3 months.
  
  
  CONCLUSIONS
  In most cases of DILI, withdrawing the toxic drug is sufficient treatment, but we must be aware of a possible fatal outcome in case of progressive cholestasis. Corticosteroids may have beneficial effects in these patients.<br />
authors.affiliation: Department of Gastroenterology, Hepatology and Immunology, Children's Memorial Health Institute, Warsaw, Poland.
authors.forename: Monika
authors.initials: M
authors.lastname: Studniarz
authors.forename: Piotr
authors.initials: P
authors.lastname: Czubkowski
authors.forename: Joanna
authors.initials: J
authors.lastname: Cielecka-Kuszyk
authors.forename: Irena
authors.initials: I
authors.lastname: Jankowska
authors.forename: Mikołaj
authors.initials: M
authors.lastname: Teisseyre
authors.forename: Diana
authors.initials: D
authors.lastname: Kamińska
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Markiewicz
authors.forename: Dorota
authors.initials: D
authors.lastname: Broniszczak
authors.forename: Joanna
authors.initials: J
authors.lastname: Pawłowska
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000009:adverse effects*; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000188:drug therapy* / Q000209:etiology* / Q000473:pathology; D002648:Child; D002756:Cholagogues and Choleretics / Q000008:administration & dosage; D002780:Cholestasis, Intrahepatic / Q000139:chemically induced* / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D012141:Respiratory Tract Infections / Q000188:drug therapy; D014580:Ursodeoxycholic Acid / Q000008:administration & dosage
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D002756:Cholagogues and Choleretics; D014580:Ursodeoxycholic Acid; D019980:Amoxicillin-Potassium Clavulanate Combination; D008775:Methylprednisolone