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首页> 外文期刊>Clinical therapeutics >Fatal acute hepatitis after sequential treatment with levofloxacin, doxycycline, and naproxen in a patient presenting with acute Mycoplasma pneumoniae infection.
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Fatal acute hepatitis after sequential treatment with levofloxacin, doxycycline, and naproxen in a patient presenting with acute Mycoplasma pneumoniae infection.

机译：序贯用左氧氟沙星，强力霉素和萘普生连续治疗的急性肺炎支原体感染患者中的致命性急性肝炎。

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BACKGROUND: The diagnosis of drug-induced liver injury relies on comprehensive clinical assessments due to the absence of an established biomarker or pathognomonic features of liver histology. However, prompt recognition of a culprit drug as the cause of liver injury is the most important aspect in the management of hepatotoxicity. CASE SUMMARY: A 63-year-old white male (85 kg) was admitted because of community-acquired pneumonia with associated pericarditis and subclinical hepatitis, subsequently related to acute Mycoplasma pneumoniae infection (diagnostic positive immuno-globulin M enzyme immunoassay, on hospital days 5 and 20). The patient had received cisplatin and radiotherapy from March to May 2006, as treatment for pharyngolaryngeal squamous cell carcinoma T3N0M0 without subsequent evidence of localized or meta-static recurrent disease (last oncologic consultation, May 17, 2007). He reported alcohol ingestion until March 2006 but no known liver disease, blood transfusion, or exposure to mushrooms or industrial cleaning solvents. Results of serologic tests for viral and nonviral infectious hepatitis, iron and copper studies, and tests for autoantibodies were normal or negative. The patient became initially asymptomatic and fever disappeared following sequential treatment with levo-floxacin (500 mg BID), doxycycline (100 mg BID), and naproxen (500 mg TID). However, on hospital day 10 jaundice and a significant elevation (alanine aminotransferase, 1577 U/L; aspartate amino-transferase, 1754 U/L; alkaline phosphatase, 189 U/L) of serum transaminases appeared. Despite the discontinuation of all medication, the patient gradually deteriorated and died 27 days after admission due to acute fulminant hepatic failure. Autopsy revealed massive hepatic necrosis, inflammatory changes with presence of eosinophils, and cholestasis. An objective causality assessment scale (Council for International Organizations of Medical Sciences/Roussel Uclaf Causality Assessment Method scale) suggested that each of the 3 drugs could "probably" (score = 6) be related to the patient's fulminant hepatitis. The Naranjo Adverse Drug Reactions Probability Scale assessment for the same drugs indicated a "possible" causal relation (score = 2). CONCLUSION: We report a case of lethal hepatitis possibly/probably associated with levofloxacin, doxy-cycline, and naproxen in a patient with acute M pneumoniae infection.
机译：背景：由于缺乏确定的肝组织学生物标志物或病理组织学特征，药物性肝损伤的诊断依赖于全面的临床评估。然而，在肝毒性的治疗中，迅速认识到引起肝损伤的罪魁祸首是最重要的方面。病例摘要：一名63岁的白人男性（85公斤）因社区获得性肺炎并伴有心包炎和亚临床性肝炎而入院，随后与急性支原体肺炎感染相关（诊断阳性的免疫球蛋白M酶免疫测定，在医院住院） 5和20）。该患者于2006年3月至2006年5月接受顺铂和放疗，作为咽喉鳞状细胞癌T3N0M0的治疗方法，但没有随后的局部或转移性复发疾病证据（最新肿瘤咨询，2007年5月17日）。他报告饮酒至2006年3月，但没有已知的肝病，输血或暴露于蘑菇或工业清洁溶剂的情况。病毒性和非病毒性传染性肝炎的血清学检测结果，铁和铜研究以及自身抗体检测结果均为正常或阴性。患者先后服用左氧氟沙星（500 mg BID），多西环素（100 mg BID）和萘普生（500 mg TID）连续治疗后无症状，发烧消失。但是，在医院第10天出现黄疸，血清转氨酶显着升高（丙氨酸氨基转移酶1577 U / L;天冬氨酸氨基转移酶1754 U / L;碱性磷酸酶189 U / L）。尽管停止了所有药物治疗，但患者仍因急性暴发性肝衰竭而逐渐恶化并在入院后27天死亡。尸检显示大量肝坏死，存在嗜酸性粒细胞和胆汁淤积的炎症变化。客观因果关系评估量表（国际医学科学组织理事会/ Roussel Uclaf因果关系评估方法量表）表明，这三种药物中的每一种都可能“可能”（得分= 6）与患者的暴发性肝炎有关。相同药物的Naranjo药物不良反应概率量表评估表明存在“可能的”因果关系（得分= 2）。结论：我们报告一例急性肺炎支原体感染患者的致命肝炎可能/可能与左氧氟沙星，强力霉素和萘普生有关。

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