title: Acute cholestatic hepatitis caused by amoxicillin/clavulanate.
abstract: Amoxicillin/clavulanate is a synthetic penicillin that is currently commonly used, especially for the treatment of respiratory and cutaneous infections. In general, it is a well-tolerated oral antibiotic. However, amoxicillin/clavulanate can cause adverse effects, mainly cutaneous, gastrointestinal, hepatic and hematologic, in some cases. Presented here is a case report of a 63-year-old male patient who developed cholestatic hepatitis after recent use of amoxicillin/clavulanate. After 6 wk of prolonged use of the drug, he began to show signs of cholestatic icterus and developed severe hyperbilirubinemia (total bilirubin > 300 mg/L). Diagnostic investigation was conducted by ultrasonography of the upper abdomen, serum tests for infection history, laboratory screening of autoimmune diseases, nuclear magnetic resonance (NMR) of the abdomen with bile duct-NMR and transcutaneous liver biopsy guided by ultrasound. The duration of disease was approximately 4 mo, with complete resolution of symptoms and laboratory changes at the end of that time period. Specific treatment was not instituted, only a combination of anti-emetic (metoclopramide) and cholestyramine for pruritus.
authors.affiliation: Daniel Oliveira Beraldo, Joanderson Fernandes Melo, Alexandre Vidal Bonfim, Andrei Alkmim Teixeira, Ricardo Alkmim Teixeira, Department of Internal Medicine, Hospital Renascentista, Pouso Alegre, MG 37550-000, Brazil.
authors.forename: Daniel Oliveira
authors.initials: DO
authors.lastname: Beraldo
authors.affiliation: Daniel Oliveira Beraldo, Joanderson Fernandes Melo, Alexandre Vidal Bonfim, Andrei Alkmim Teixeira, Ricardo Alkmim Teixeira, Department of Internal Medicine, Hospital Renascentista, Pouso Alegre, MG 37550-000, Brazil.
authors.forename: Joanderson Fernandes
authors.initials: JF
authors.lastname: Melo
authors.affiliation: Daniel Oliveira Beraldo, Joanderson Fernandes Melo, Alexandre Vidal Bonfim, Andrei Alkmim Teixeira, Ricardo Alkmim Teixeira, Department of Internal Medicine, Hospital Renascentista, Pouso Alegre, MG 37550-000, Brazil.
authors.forename: Alexandre Vidal
authors.initials: AV
authors.lastname: Bonfim
authors.affiliation: Daniel Oliveira Beraldo, Joanderson Fernandes Melo, Alexandre Vidal Bonfim, Andrei Alkmim Teixeira, Ricardo Alkmim Teixeira, Department of Internal Medicine, Hospital Renascentista, Pouso Alegre, MG 37550-000, Brazil.
authors.forename: Andrei Alkmim
authors.initials: AA
authors.lastname: Teixeira
authors.affiliation: Daniel Oliveira Beraldo, Joanderson Fernandes Melo, Alexandre Vidal Bonfim, Andrei Alkmim Teixeira, Ricardo Alkmim Teixeira, Department of Internal Medicine, Hospital Renascentista, Pouso Alegre, MG 37550-000, Brazil.
authors.forename: Ricardo Alkmim
authors.initials: RA
authors.lastname: Teixeira
authors.affiliation: Daniel Oliveira Beraldo, Joanderson Fernandes Melo, Alexandre Vidal Bonfim, Andrei Alkmim Teixeira, Ricardo Alkmim Teixeira, Department of Internal Medicine, Hospital Renascentista, Pouso Alegre, MG 37550-000, Brazil.
authors.forename: André Loyola
authors.initials: AL
authors.lastname: Duarte
mesh_terms: D019980:Amoxicillin-Potassium Clavulanate Combination / Q000009:adverse effects*; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D000932:Antiemetics / Q000627:therapeutic use; D000982:Antipruritics / Q000627:therapeutic use; D001706:Biopsy; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D049448:Cholangiopancreatography, Magnetic Resonance; D002780:Cholestasis, Intrahepatic / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D006932:Hyperbilirubinemia / Q000139:chemically induced; D007565:Jaundice / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000932:Antiemetics; D000982:Antipruritics; D019980:Amoxicillin-Potassium Clavulanate Combination
keywords: Amoxicillin/Clavulanate; Drug reactions; Hepatitis; Hepatology; Hyperbilirubinemia