Published online Dec 14, 2013. doi: 10.3748/wjg.v19.i46.8789
Revised: September 14, 2013
Accepted: September 16, 2013
Published online: December 14, 2013
Amoxicillin/clavulanate is a synthetic penicillin that is currently commonly used, especially for the treatment of respiratory and cutaneous infections. In general, it is a well-tolerated oral antibiotic. However, amoxicillin/clavulanate can cause adverse effects, mainly cutaneous, gastrointestinal, hepatic and hematologic, in some cases. Presented here is a case report of a 63-year-old male patient who developed cholestatic hepatitis after recent use of amoxicillin/clavulanate. After 6 wk of prolonged use of the drug, he began to show signs of cholestatic icterus and developed severe hyperbilirubinemia (total bilirubin > 300 mg/L). Diagnostic investigation was conducted by ultrasonography of the upper abdomen, serum tests for infection history, laboratory screening of autoimmune diseases, nuclear magnetic resonance (NMR) of the abdomen with bile duct-NMR and transcutaneous liver biopsy guided by ultrasound. The duration of disease was approximately 4 mo, with complete resolution of symptoms and laboratory changes at the end of that time period. Specific treatment was not instituted, only a combination of anti-emetic (metoclopramide) and cholestyramine for pruritus.
Core tip: This report describes a case of acute cholestatic hepatitis caused by the use of amoxicillin/clavulanate. This case presented an unusual evolution, characterized by severe hyperbilirubinemia and cholestatic symptoms without the development of hepatic failure, and with total resolution requiring no specific treatment. There are few case reports in the literature that describe a similar clinical condition due to drug-induced cholestatic hepatitis.