Korean J Transplant.  2020 Dec;34(4):279-285. 10.4285/kjt.20.0017.

Liver transplantation for azithromycin-induced severe liver injury

• Park HJ
• Seo KI
• Choi YI

• KMID: 2510267
• DOI: http://doi.org/10.4285/kjt.20.0017

Abstract

Drug-induced liver injury is the most common cause of acute liver failure in Western countries by prescription drugs and herbal medications. Liver injury due to azithromycin has rarely been reported. This is a brief report of a patient administered azithromycin and who developed acute liver failure leading to liver transplantation. We report the case of a 68-year-old woman who developed jaundice 1 week after she started taking a azith-romycin. On the 3rd day of hospitalization, her hepatic function rapidly deteriorated and level of consciousness decreased to drowsiness. The model for end-stage liver disease score was confirmed to be 33, and liver transplantation was considered. On the 8th day of hospitalization, she underwent emergency living donor liver transplantation, receiving a right lobe liver graft from a 35-year-old male donor, the patient’s son. Currently, she is alive with good liver function after 25 months of transplant. This case suggests that azithromycin may cause rare hepatitis with liver failure. Therefore, at the beginning of the azithromycin treatment, patients should visit the hospital immediately if symptoms such as jaundice and abdominal pain are experienced.

Keyword

Drug induced liver injury; Liver failure; Liver transplantation

Figure

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  Fig. 1 Trends in liver function test results of the case patient during hospitalization period and follow-up visit. TB, total bilirubin; PT, prothrombin time; LDLT, living donor liver transplantation; INR, international normalized ratio; HD, hospital day; ICU, intensive care unit; OPD, outpatient department; ALP, alkaline phosphatase; GGT, gamma-glutamyl transferase; AST, aspartate aminotransferase; ALT, alanine aminotransferase.

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  Fig. 2 Axial computed tomography scan images of the case patient. (A) Before initiating azithromycin therapy. (B) On the admission day, periportal edema (black arrows) is observed. (C) After 6 days of liver transplantation, mild periportal edema (black arrow) is observed. (D) After 1 year of discharge.

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  Fig. 3 Pathological finding of the explanted liver. (A) Gross examination. The liver is unremarkably without mass or necrosis. (B) Microscopic examination. Submassive loss of hepatocyte, hemorrhage, and ductular reaction (H&E, ×40). (C, D) Microscopic examination. Necrotic areas surrounding central vein (zone 3 necrosis; H&E, ×40 [C] and ×100 [D]).

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