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Cefuroxime axetil-induced liver failure
Fuat Ekiz
Corresponding author
dr_ekiz@yahoo.com

Correspondence and reprint request:
, O¿uz Üsküdar, Zahide Şimşek, Ilhami Yüksel, Ömer Başar, Akif Altinbaş, 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">Cefuroxime is a second-generation cephalosporin antibiotic&#46; It is effective against susceptible bacteria causing infections of the middle ear&#44; tonsillitis&#44; throat infections&#44; laryngitis&#44; bronchitis&#44; and pneumonia&#46; It is also used in treating urinary tract infections&#44; skin infections&#44; and gonorrhea&#46; It is a generally well tolerated antibiotic&#46; Common adverse effects of cefuroxime axetil are diarrhea&#44; nausea&#44; vomiting&#44; headaches&#47;migraines&#44; dizziness and abdominal pain&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In the literature&#44; only two cases were reported that cefuroxime axetil associated cholestha-tic hepatitis and ischemic hepatitis&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> There have been no published reports of liver failure associated with cefuroxime axetil&#46; Herein we presented a patient who developed liver failure associated with ce-furoxime axetil use&#46;</p><p id="p0010" class="elsevierStylePara elsevierViewall">A 60-year-old female patient was admitted to our hospital with a four-day history of jaundice and vomiting&#46; Her past medical history revealed an upper respiratory infection treated with a 10-day course of oral cefuroxime axetil 500 mg twice a day&#46; The patient has completed the treatment four days prior to presentation&#46; She denied alcohol use and was not taking any prescription or herbal medications&#46; There was no history of sexually transmitted diseases&#46; She had no relevant family and travel history&#46; Physical examination was remarkable for scleral icterus and jaundice&#46; Laboratory tests were performed&#44; total bi-lirubin&#58; 25&#44; 6 mg&#47;dL&#44; conjugated bilirubin&#58; 17&#44; 9 mg&#47; dL&#44; ALT&#58; 1527 IU&#47;mL&#44; AST&#58; 1348 IU&#47;mL&#44; ALP&#58; 1006 IU&#47;mL&#44; and GGT&#58; 381 IU&#47;mL&#46; On admission&#44; international normalized ratio &#40;INR&#41; was normal but increased to 1&#46;9 six days after admission and total bilirubin increased up to 30 mg&#47;dL and conjugated bilirubin to 20 mg&#47;dL&#44; while AST and ALT levels normalized&#46; Other biochemical tests were normal&#46; Serological markers for acute viral hepatitis were negative for anti hepatitis A IgM&#44; anti-hepatitis B core IgM&#44; CMV&#44; EBV&#44; herpes simplex viruses and hepatitis B surface antigen&#46; Hepatitis C and HIV antibodies were negative&#46; HBV-DNA and HCV RNA were negative&#46; Liver ultrasound was normal&#46; Autoimmune hepatitis markers including antinuclear antibody and smooth muscle antibody were negative with normal serum immunoglobulin levels&#46; MELD score increased to 26 and patient was discussed about liver transplantation&#46; Ursodeoxycolic acid &#40;UDCA&#41; was initiated two weeks after initial presentation&#46; Within seven weeks from admission&#44; her symptoms didn&#8217;t resolve&#44; the bilirubin levels and INR didn&#8217;t return to normal range&#46; She was transferred to liver transplantation center&#46; After ten weeks later from admittance the patient recovered and laboratory parameters returned to normal&#46;</p><p id="p0015" class="elsevierStylePara elsevierViewall">There are only a few case reports implicating other cephalosporins as the cause of hepatotoxicity in adults&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Even though&#44; cholestatic type toxicity and ischemic hepatitis were reported before&#44; to our knowledge&#44; our case is first presentation of liver failure with cefuroxime axetil&#46; In conclusion&#44; physicians should be aware of hepatotoxicity due to cefuroxime axetil since it is a widespread used anti-biotic&#46;</p></span>"
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