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A rare case of recurrent prolonged hepatotoxicity due to ornidazole
Bariş Yilmaz
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drbarisy@gmail.com

Correspondece and reprint request:
, Fuat Ekiz*, Ilhami Yüksel*, Akif Altinbas*, Murat Deveci*, Osman Yüksel*
* Diskapi Yildirim Beyazit Educational and Research Hospital, Department of Gastroenterology, Ankara, Turkey
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="p0005" class="elsevierStylePara elsevierViewall">Ornidazole is generally well tolerated antibiotic which is synthetic derivative of nitroimidazole&#46; Serious side effects are very rarely encountered&#46; The most common side effects are metallic taste&#44; nausea&#44; vomiting&#44; abdominal pain and diarrhea&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Even though it has been presented that ornidazole has side effects &#40;for example neurotoxicity&#44; glossitis and stomatitis&#41;&#46; Hepatotoxicity related to this drug has been rarely reported&#46; Before&#44; this phenomenon was described with the three cases by Tabak&#44; <span class="elsevierStyleItalic">et al&#46;</span><a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Herein&#44; we presented a case of recurrent prolonged he-patotoxicity associated with ornidazole&#46;</p><p id="p0010" class="elsevierStylePara elsevierViewall">A 45-years-old female patient was admitted to our outpatient clinic with nausea&#44; vomiting&#44; loss of appetite&#44; jaundice and abdominal pain&#46; Her past medical history revealed vaginitis treated with two days course of oral ornidazole 500 mg twice daily&#46; She also mentioned about ornidazole associated hepatitis following use of the drug a year ago&#46; Meanwhile&#44; elevated liver enzymes after ornidazole treatment in that period were as follows&#58; ALT 720 U&#47;l&#44; AST 690 U&#47;l&#44; alkaline phosphatase 161 U&#47;l&#44; GGT 102 U&#47;l&#44; total bilirubin 8&#46;2 mg&#47;dl&#44; direct bilirubin 4&#46;0 mg&#47;dl&#46; On admission&#44; physical examination revealed scleral jaundice and tenderness in the right upper quadrant&#46; Laboratory examination revealed the following&#58; ALT 397 U&#47;l&#44; AST 333 U&#47;l&#44; GGT 68&#44; total bilirubin 1&#44; 94 mg&#47;dl&#46; Alkaline phosphatase&#44; albumin and prothrombin time were normal&#46; She did not consume alcohol&#46; She did not take herbal products and concomitant medication&#46; She had not travelled any region of the world&#46; Laboratory tests were normal for autoimmune hepatitis&#44; thyroid tests&#44; haemo-chromatosis or Wilson&#8217;s disease&#46; Viral markers for A-E were negative&#46; Antinuclear antibody was negative&#46; Hepatobiliary ultrasound revealed no evidence of extrahepatic obstruction&#44; biliary ductal disease&#44; hepatic parenchymal abnormalities&#44; or cholelithiasis&#46; These findings suggested hepatocellular type liver injury related with ornidazole&#46; After ceasing the drug&#44; transaminase and bilirubin levels returned to normal range after two months&#46; We didn&#8217;t perform percutaneous liver biopsy because of liver function tests decreased to normal range and the patient didn&#8217;t accept&#46; Besides she had a history of ornidazole induced hepatotoxicity&#46;</p><p id="p0015" class="elsevierStylePara elsevierViewall">Ornidazole induced liver injury may be cytolytic&#44; cholestatic&#44; and&#47;or mixed&#46; In this report&#44; we described a patient recurrent hepatitis due to ornidazole&#46; Interestingly&#44; hepatotoxicity due to ornidazole was appeared early as compared with previous cases&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In conclusion&#44; ornidazole which is frequently used nitroimidazole derivative may cause recurrent hepatitis&#46; Physicians and patients should be awareness of hepatotoxicity due to ornidazole&#46; Early recognition and withdrawal of the drug may prevent further damage&#46;</p></span>"
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