Rifabutin Hepatotoxicity in a Pediatric Liver Transplant Patient

Abstract

Objective:

To report a case of hepatotoxicity associated with administration of rifabutin in a pediatric liver transplant patient.

Case Summary:

A child developed disseminated Mycobacterium avium-intracellulare eight years after liver transplantation, requiring a reduction in immunosuppression and concomitant therapy with amikacin, azithromycin, ciprofloxin, ethambutol, and clofazimine. Despite clinical improvement, rifabutin was added because of residual sterile hepatic and pulmonary granuloma identified during preparation for retransplantation. She developed acute hepatic decompensation upon initiation of rifabutin, which resolved after discontinuation of this antibiotic.

Conclusions:

This case demonstrates the potential for serious hepatotoxicity with the use of rifabutin in complicated medical patients with hepatic insufficiency.