Clinical and Histopathologic Features of Fluoroquinolone-Induced Liver Injury

Eric Orman, Hari S. Conjeevaram, Raj Vuppalanchi, James W. Freston, James Rochon, David E. Kleiner, Paul H. Hayashi

Research output: Contribution to journalArticle

58 Citations (Scopus)

Abstract

Background & Aims: Fluoroquinolone-induced liver injury is rare; no prospective studies of well-characterized case series have been published. We studied patients with fluoroquinolone-induced hepatotoxicity from the Drug-Induced Liver Injury Network (DILIN) to characterize injury patterns, outcomes, and associated features. Methods: We identified subjects with fluoroquinolone hepatotoxicity enrolled in the DILIN from September 2004 to January 2010. Demographic, clinical, and laboratory data were analyzed by descriptive statistical methods. Results: Of the 679 registrants in the DILIN prospective study, 12 had fluoroquinolone hepatotoxicity (6 ciprofloxacin, 4 moxifloxacin, 1 levofloxacin, and 1 gatifloxacin). Seven were women; median age was 57 years (range, 23-80 years), and median time from fluoroquinolone start to symptoms was only 4 days (range, 1-39 days). Nine patients developed symptoms on medication; 3 did so 2, 8, and 32 days after stopping the medication. Cases were equally distributed among hepatocellular injury (predominantly increased levels of alanine aminotransferase), cholestatic injury (predominantly increased levels of alkaline phosphatase), and both. Seven patients had immunoallergic features. Patients with mixed hepatocellular and cholestatic injury had mild disease without jaundice; all recovered. In contrast, 2 of 4 patients with hepatocellular injury and jaundice died, 1 of acute liver failure. One patient with cholestatic injury developed vanishing bile duct syndrome and required liver transplantation; another had a persistently increased serum level of alkaline phosphatase. Conclusions: Fluoroquinolone liver injury is rapid in onset and often has immunoallergic features, indicating a hypersensitivity reaction. The pattern of injury can be hepatocellular, cholestatic, or mixed; mixed cases are the least severe. Acute and chronic liver failure can occur.

Original languageEnglish
JournalClinical Gastroenterology and Hepatology
Volume9
Issue number6
DOIs
StatePublished - Jun 2011

Fingerprint

Fluoroquinolones
Liver
Wounds and Injuries
Chemical and Drug Induced Liver Injury
Acute Liver Failure
Jaundice
Alkaline Phosphatase
Prospective Studies
Levofloxacin
End Stage Liver Disease
Ciprofloxacin
Bile Ducts
Alanine Transaminase
Liver Transplantation
Hypersensitivity
Demography

Keywords

  • Adverse Reaction
  • ALT
  • Antibiotics
  • Drug Toxicity
  • Side Effect

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Clinical and Histopathologic Features of Fluoroquinolone-Induced Liver Injury. / Orman, Eric; Conjeevaram, Hari S.; Vuppalanchi, Raj; Freston, James W.; Rochon, James; Kleiner, David E.; Hayashi, Paul H.

In: Clinical Gastroenterology and Hepatology, Vol. 9, No. 6, 06.2011.

Research output: Contribution to journalArticle

Orman, Eric ; Conjeevaram, Hari S. ; Vuppalanchi, Raj ; Freston, James W. ; Rochon, James ; Kleiner, David E. ; Hayashi, Paul H. / Clinical and Histopathologic Features of Fluoroquinolone-Induced Liver Injury. In: Clinical Gastroenterology and Hepatology. 2011 ; Vol. 9, No. 6.
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