Fulminant Hepatic Failure Possibly Related to Ciprofloxacin

Abstract

OBJECTIVE:

To report a case of hepatic failure in a patient who was receiving oral ciprofloxacin.

DATA SOURCES:

Case reports, review articles, and relevant laboratory studies identified by MEDLINE.

DATA EXTRACTION:

Data were abstracted from pertinent published sources by one author and reviewed by the remaining authors.

DATA SYNTHESIS:

A 66-year-old man was admitted for hip arthroplasty and developed fulminant hepatic failure during oral ciprofloxacin therapy. Ciprofloxacin was started on postoperative day 13 for treatment of a urinary tract infection. Over the next three days he became confused and hypoglycemic. His prothrombin time increased to >90 s. Serum aspartate aminotransferase and alanine aminotransferase concentrations were markedly elevated. The patient died on postoperative day 20. Postmortem examination of the liver revealed extensive centrilobular necrosis. A skin biopsy was consistent with a drug reaction. It is unknown whether the patient had received a quinolone compound in the past or had a history of exposure to hepatotoxins.

CONCLUSIONS:

It cannot be concluded that ciprofloxacin directly caused hepatic failure in this patient. It is possible that the drug evoked a hypersensitivity reaction or exacerbated a preexisting hepatotoxicity. A detailed patient history and evaluation of hepatic function should be obtained prior to initiating ciprofloxacin therapy. A nonquinolone antimicrobial may be a safer alternative for patients with hepatic dysfunction.