Document Detail


Cholangiopathy after short-term administration of piperacillin and imipenem/cilastatin.
MedLine Citation:
PMID:  11422785     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We describe a patient who suffered from intestinal perforation after abdominal trauma. Perioperatively, he was treated with a single dose of piperacillin and 9 doses of imipenem/cilastatin over 3 days. The patient was discharged 5 days after surgery in good clinical condition and with normal liver values except for a marginal elevation of alanine aminotransferase. Two weeks after discharge, he developed fatigue, fever and pruritus, necessitating rehospitalization. He was jaundiced and had elevated alkaline phosphatase and transaminases. After exclusion of an intra-abdominal fluid collection, a vascular problem, and infectious or autoimmune liver disease, a liver biopsy was performed. The biopsy revealed centrizonal bilirubinostasis, a portal infiltrate rich in eosinophils and cholangitis. Lymphocyte transformation tests for piperacillin and imipenem/cilastatin were positive, suggesting an immunological mechanism for the observed hepatopathy. Cholestasis gradually decreased but was detectable for several weeks. The patient had a full clinical and biochemical recovery after 3 months. We conclude that short-term therapy with piperacillin, imipenem/cilastatin or the combination of these drugs can lead to the same type of hepatopathy as described for amoxycillin/clavulanic acid or antistaphylococcal penicillins. Liver biopsy and positive lymphocyte transformation are compatible with an immunological mechanism.
Authors:
C Quattropani; M Schneider; A Helbling; A Zimmermann; S Krähenbühl
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Liver     Volume:  21     ISSN:  0106-9543     ISO Abbreviation:  Liver     Publication Date:  2001 Jun 
Date Detail:
Created Date:  2001-06-25     Completed Date:  2001-08-23     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8200939     Medline TA:  Liver     Country:  Denmark    
Other Details:
Languages:  eng     Pagination:  213-6     Citation Subset:  IM    
Affiliation:
Departments of Clinical Pharmacology,Visceral and Transplantation Surgery,Clinical Immunology and Pathology, University of Berne, Switzerland.
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MeSH Terms
Descriptor/Qualifier:
Adult
Alanine Transaminase / blood
Alkaline Phosphatase / blood
Aspartate Aminotransferases / blood
Bilirubin / blood
Biopsy
Cholangitis / blood,  chemically induced*
Cilastatin / adverse effects*
Drug Therapy, Combination
Humans
Imipenem / adverse effects*
Liver / drug effects,  pathology
Lymphocyte Activation / drug effects
Male
Penicillins / adverse effects*
Piperacillin / adverse effects*
Protease Inhibitors / adverse effects*
Thienamycins / adverse effects*
Chemical
Reg. No./Substance:
0/Penicillins; 0/Protease Inhibitors; 0/Thienamycins; 61477-96-1/Piperacillin; 635-65-4/Bilirubin; 74431-23-5/Imipenem; 82009-34-5/Cilastatin; EC 2.6.1.1/Aspartate Aminotransferases; EC 2.6.1.2/Alanine Transaminase; EC 3.1.3.1/Alkaline Phosphatase

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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