title: Possible Hepatotoxicity Associated With Daptomycin: A Case Report and Literature Review.
abstract: OBJECTIVE
  To report a case of isolated daptomycin-induced acute liver injury without elevations in creatine kinase (CK) levels or kidney dysfunction.
  
  
  CONCLUSIONS
  A 49-year-old female with a history of pancreatitis, lupus, diabetes, congestive heart failure, hypertension, and chronic pain syndrome presented to the emergency department with alteration in mental status and acute liver failure. The patient had been treated with daptomycin for methicillin-resistant Staphylococcus aureus (MRSA) endocarditis for 3 weeks. After ruling out other possible etiologies, daptomycin was suspected as a cause of acute liver failure. Her liver failure resolved gradually following withdrawal of daptomycin.
  
  
  CONCLUSIONS
  Although hepatic abnormalities caused by daptomycin are rare, a handful of cases with daptomycin-induced liver injury have been reported in the literature. Of note, in most cases, patients on daptomycin therapy developed liver damage with elevations in CK levels. Our case report suggests possible severe liver injury associated with high-dose and long-term daptomycin treatment in the absence of rhabdomyolysis. Future research is warranted to further investigate the relationship between daptomycin use and liver injury, yet it is reasonable to monitor liver function tests at baseline and weekly thereafter along with CK levels, especially in patients requiring long-term daptomycin therapy.
authors.affiliation: Critical Care, Western New England University College of Pharmacy, Springfield, MA, USA Critical Care, Mercy Medical Center, Springfield, MA, USA yoonsun.mo@wne.edu.
authors.forename: Yoonsun
authors.initials: Y
authors.lastname: Mo
authors.affiliation: Sisters of Providence Health System, Springfield, MA, USA.
authors.forename: Fletcher
authors.initials: F
authors.lastname: Nehring
authors.affiliation: Costco Pharmacy, Westlake Village, CA, USA.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Jung
authors.affiliation: Infectious Disease, Western New England University College of Pharmacy, Springfield, MA, USA.
authors.forename: Seth T
authors.initials: ST
authors.lastname: Housman
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000097:blood; D056486:Chemical and Drug Induced Liver Injury / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D017576:Daptomycin / Q000009:adverse effects* / Q000097:blood; D005260:Female; D006801:Humans; D008875:Middle Aged
chemical_list: D000900:Anti-Bacterial Agents; D017576:Daptomycin
keywords: critical care; infectious disease; internal medicine; medication safety