title: Worsening cholestasis and possible cefuroxime-induced liver injury following "successful" therapeutic endoscopic retrograde cholangiopancreatography for a distal common bile duct stone: a case report.
abstract: BACKGROUND
  Cefuroxime very rarely causes drug-induced liver injury. We present a case of a patient with paradoxical worsening of jaundice caused by cefuroxime-induced cholestasis following therapeutic endoscopic retrograde cholangiopancreatography for a distal common bile duct stone.
  
  
  METHODS
  A 51-year-old, previously healthy Sri Lankan man presented to our hospital with obstructive jaundice caused by a distal common bile duct stone. Endoscopic retrograde cholangiopancreatography with stone extraction, common bile duct clearance, and stenting failed to improve the cholestasis, with paradoxical worsening of his jaundice. A liver biopsy revealed features of drug-induced intrahepatic cholestasis. Although his case was complicated by an episode of cholangitis, the patient made a complete recovery in 4 months with supportive treatment and withdrawal of the offending drug.
  
  
  CONCLUSIONS
  This case highlights a very rare drug-induced liver injury caused by cefuroxime as well as our approach to treating a patient with paradoxical worsening of jaundice after therapeutic endoscopic retrograde cholangiopancreatography.
authors.affiliation: Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka. maduniln@yahoo.co.uk.
authors.forename: Madunil Anuk
authors.initials: MA
authors.lastname: Niriella
authors.affiliation: Colombo North Teaching Hospital, Ragama, Sri Lanka.
authors.forename: Ravindu Sujeewa
authors.initials: RS
authors.lastname: Kumarasena
authors.affiliation: Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
authors.forename: Anuradha Supun
authors.initials: AS
authors.lastname: Dassanayake
authors.affiliation: Faculty of Medical Sciences, University of Sri Jayawardenapura, Colombo, Sri Lanka.
authors.forename: Aloka
authors.initials: A
authors.lastname: Pathirana
authors.affiliation: Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
authors.forename: Janaki
authors.initials: J
authors.lastname: de Silva Hewavisenthi
authors.affiliation: Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
authors.forename: Hithanadura Janaka
authors.initials: HJ
authors.lastname: de Silva
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects*; D002444:Cefuroxime / Q000008:administration & dosage*; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002779:Cholestasis / Q000175:diagnosis* / Q000628:therapy; D003135:Common Bile Duct / Q000473:pathology; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology*; D008099:Liver / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D002444:Cefuroxime
keywords: Cefuroxime; Cholestasis; Drug-induced liver injury; ERCP