title: A curious case of cholestasis: oral terbinafine associated with cholestatic jaundice and subsequent erythema nodosum.
abstract: Terbinafine is a commonly prescribed antifungal agent used in the treatment of trichophytic onychomycosis and chronic cutaneous mycosis that are resistant to other treatments. This case report highlights a rarely documented but important adverse hepatic reaction that was caused by the use of oral terbinafine. A woman in her thirties presented with a 3-week history of jaundice, malaise, itching, nausea, decreased appetite, weight loss, dark orange urine and intermittent non-radiating epigastric pain. She had recently finished a 3-week course of oral terbinafine for a fungal nail infection. Liver biopsy findings were consistent with chronic active hepatitis secondary to a drug reaction. A few days after initial presentation, the patient developed erythema nodosum. Delayed development of erythema nodosum secondary to terbinafine could not be excluded.
authors.affiliation: North Middlesex University Hospital NHS Trust, London, UK.
authors.forename: Kartik
authors.initials: K
authors.lastname: Kumar
authors.affiliation: North Middlesex University Hospital NHS Trust, London, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Gill
authors.affiliation: North Middlesex University Hospital NHS Trust, London, UK.
authors.forename: Rachelle
authors.initials: R
authors.lastname: Shafei
authors.affiliation: North Middlesex University Hospital NHS Trust, London, UK.
authors.forename: Janine L
authors.initials: JL
authors.lastname: Wright
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000935:Antifungal Agents / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000150:complications / Q000175:diagnosis*; D002779:Cholestasis / Q000139:chemically induced / Q000150:complications / Q000175:diagnosis*; D003937:Diagnosis, Differential; D004893:Erythema Nodosum / Q000209:etiology; D005260:Female; D006801:Humans; D007565:Jaundice / Q000209:etiology; D009260:Nail Diseases / Q000188:drug therapy; D009281:Naphthalenes / Q000009:adverse effects*; D011537:Pruritus / Q000209:etiology; D000077291:Terbinafine
chemical_list: D000935:Antifungal Agents; D009281:Naphthalenes; D000077291:Terbinafine