Abstract
BACTRIM-INDUCED ACUTE LIVER FAILURE: A CASE REPORT AND REVIEW OF LITERATURE

Daniel Kasho Williams*, Benish Alam, Cynthia Ifejika, Chidinma Vivian Ikekpeazu, Maryam Ahmed, Okika Ebuka Jude

ABSTRACT

Background: Drug-induced Liver Injury (DILI) is considered the most common cause of acute liver injury in the western world. Antibiotics are most frequently the offending agent in DILI. The treatment of DILI is the discontinuation of the offending agent. In the vast majority of cases, patients fully recover clinically and biochemically. Case Presentation: We present a 73-year-old male patient with a medical history significant for chronic obstructive pulmonary disease (COPD), hypertension, and recent community-acquired pneumonia (CAP) who presented to the emergency department (ED) for the evaluation of generalized pruritus and mild confusion. His presentation was concerning for acute liver injury. Bactrim was stopped on admission. Testing for Autoimmune, viral hepatitis, and acetaminophen toxicity was negative, with liver biopsy showing mild reactive changes and patchy hepatic steatosis consistent with DILI. The patient’s LFTs started trending down, along with improved clinical symptoms over the next few days. Discussion: Trimethoprim-sulfamethoxazole is a commonly prescribed antibiotic in the USA. It induces liver injury through a hypersensitivity reaction and can vary from mild transaminitis to acute liver failure. The diagnosis is made by ruling out other causes of liver injury, and the treatment is generally supportive and rarely requires corticosteroids.

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