Posters
Academic Level (Author 1)
Resident
Discipline/Specialty (Author 1)
Internal Medicine
Discipline Track
Clinical Science
Abstract
Abstract Drug induced liver injury (DILI) is a cause of significant morbidity; timely diagnosis is important and requires a high index of suspicion. Terbinafine induced liver injury is rare. We report a case of Terbinafine induced hepatitis-cholestatic injury. The patient had a prolonged recovery phase lasting three months after discontinuation of drug.
Background A 44-year-old Gentleman presented to the hospital with history of pruritus and progressive jaundice. He had been taking Terbinafine 250 mg once a day for onychomycosis for a total duration of 7 weeks after which he developed jaundice, pruritus, and dark urine. He had no history of any systemic disease and rarely drank alcoholic beverages. Terbinafine was stopped and he was investigated thoroughly; his liver functions tests revealed mixed cholestatic hepatitis picture (bilirubin 7.9 mg/dL, AST 45 U/L, ALT 55 U/L, ALP 275 U/L), blood counts were normal (hemoglobin 14.1 g/dL, total leukocyte count 6950/μL, platelet count 314,000/μL), viral serologies (HBsAg, anti-HCV, hepatitis B virus DNA, hepatitis C virus RNA, IgM anti-HAV, IgM anti-HEV) were negative, markers for autoimmune liver disease were negative (anti-nuclear antibody, anti-smooth muscle antibody, anti-mitochondrial antibody, anti-liver kidney microsomal antibody), he had normal values of serum Ceruloplasmin and Ferritin, USG abdomen was negative for biliary obstruction. A diagnosis of Terbinafine induced liver injury was made (RUCAM score 8, highly probable) and he was given Ursodeoxycholic acid 300 mg three times a day till normalization of liver function tests, which was for a total duration of three months. His liver function tests improved gradually during this period.
Conclusion Due to the rarity of liver injury caused by antifungal Terbinafine is important to have a high index of suspicion when a patient presents with a typical picture of cholestasis. Drug induce liver injury is a cause of significant morbidity, once diagnosed the medications have to be removed.
Presentation Type
Poster
Recommended Citation
Gutierrez, Denis X. and Garcia Cruz, Jian, "Terbinafine induced liver injury is rare. We report a case of Terbinafine induced hepatitis-cholestatic injury." (2024). Research Colloquium. 34.
https://scholarworks.utrgv.edu/colloquium/2023/posters/34
Included in
Terbinafine induced liver injury is rare. We report a case of Terbinafine induced hepatitis-cholestatic injury.
Abstract Drug induced liver injury (DILI) is a cause of significant morbidity; timely diagnosis is important and requires a high index of suspicion. Terbinafine induced liver injury is rare. We report a case of Terbinafine induced hepatitis-cholestatic injury. The patient had a prolonged recovery phase lasting three months after discontinuation of drug.
Background A 44-year-old Gentleman presented to the hospital with history of pruritus and progressive jaundice. He had been taking Terbinafine 250 mg once a day for onychomycosis for a total duration of 7 weeks after which he developed jaundice, pruritus, and dark urine. He had no history of any systemic disease and rarely drank alcoholic beverages. Terbinafine was stopped and he was investigated thoroughly; his liver functions tests revealed mixed cholestatic hepatitis picture (bilirubin 7.9 mg/dL, AST 45 U/L, ALT 55 U/L, ALP 275 U/L), blood counts were normal (hemoglobin 14.1 g/dL, total leukocyte count 6950/μL, platelet count 314,000/μL), viral serologies (HBsAg, anti-HCV, hepatitis B virus DNA, hepatitis C virus RNA, IgM anti-HAV, IgM anti-HEV) were negative, markers for autoimmune liver disease were negative (anti-nuclear antibody, anti-smooth muscle antibody, anti-mitochondrial antibody, anti-liver kidney microsomal antibody), he had normal values of serum Ceruloplasmin and Ferritin, USG abdomen was negative for biliary obstruction. A diagnosis of Terbinafine induced liver injury was made (RUCAM score 8, highly probable) and he was given Ursodeoxycholic acid 300 mg three times a day till normalization of liver function tests, which was for a total duration of three months. His liver function tests improved gradually during this period.
Conclusion Due to the rarity of liver injury caused by antifungal Terbinafine is important to have a high index of suspicion when a patient presents with a typical picture of cholestasis. Drug induce liver injury is a cause of significant morbidity, once diagnosed the medications have to be removed.