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Case report
Prednisolone: role in amoxicillin–clavulanate-induced cholestatic liver injury
  1. Melvin Qiyu Lee1,
  2. Royale Chigozie1,
  3. Irfan Khan2 and
  4. Gerard O'Mara2
  1. 1 Medicine, Saolta University Health Care Group, Galway, Ireland
  2. 2 Medicine, Roscommon University Hospital, Roscommon, Ireland
  1. Correspondence to Dr Melvin Qiyu Lee; melvinqlee{at}rcsi.ie

Abstract

A 68-year-old patient presented with symptoms of a urinary tract infection. A deterioration in the patient’s liver function tests (LFTs) was noted 1 week following completion of a course of amoxicillin–clavunalate. This progressively worsened, reaching its peak by day 30. Our investigations excluded other possible causes for deranged LFTs and there was no improvement of same despite reduced dosing of potentially hepatotoxic medications.

A trial of 30 mg/day prednisolone was commenced, resulting in an immediate and progressive improvement in LFTs to baseline over a period of 22 days and an improvement in constitutional symptoms such as tiredness and poor appetite. Drug-induced liver injury (DILI) is one of the common causes of acute hepatitis and a leading cause of acute liver failure in the US and Europe. Patterns of DILI can be generally divided into: (1) hepatocellular injury, (2) cholestatic injury and (3) mixed injury.

  • drugs and medicines
  • unwanted effects / adverse reactions
  • liver disease

https://doi.org/10.1136/bcr-2020-239488

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    Footnotes

    • Contributors MQL: role in substantial contributions to the conception, design of the work, analysis and interpretation of data. Patient’s follow up. IK: revising and suggest changes in the content and role in patient’s care during admission. RC: editing the case report before final approval from consultant. Refine the design and content of case report. GO’M: consultant of the team. Final approval of the version published.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.