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Guido MV, Jithpratuck W, Parks GE, et al. Nafcillin-Induced Allergic Eosinophilic Cholestatic Hepatitis. Gastroenterology Res. 2017;10(3):202-207doi: 10.14740/gr824w.
Guido, M. V., Jithpratuck, W., Parks, G. E., & Krishnaswamy, G. (2017). Nafcillin-Induced Allergic Eosinophilic Cholestatic Hepatitis. Gastroenterology research, 10(3), 202-207. https://doi.org/10.14740/gr824w
Guido, Mark V, et al. "Nafcillin-Induced Allergic Eosinophilic Cholestatic Hepatitis." Gastroenterology research vol. 10,3 (2017): 202-207. doi: https://doi.org/10.14740/gr824w
Guido MV, Jithpratuck W, Parks GE, Krishnaswamy G. Nafcillin-Induced Allergic Eosinophilic Cholestatic Hepatitis. Gastroenterology Res. 2017 Jun;10(3):202-207. doi: 10.14740/gr824w. Epub 2017 Jun 30. PMID: 28725311; PMCID: PMC5505289.
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Gastroenterology Res. 2017 Jun;10(3):202-207. doi: 10.14740/gr824w. Epub 2017 Jun 30.

Nafcillin-Induced Allergic Eosinophilic Cholestatic Hepatitis.

Gastroenterology research

Mark V Guido, Warit Jithpratuck, Graham E Parks, Guha Krishnaswamy

Affiliations

  1. Department of Internal Medicine, Wake Forest Baptist Medical Center, Winston Salem, NC, USA.
  2. CJW Medical Center, Richmond, VA, USA.
  3. Department of Pathology, Wake Forest Baptist Medical Center, Winston Salem, NC, USA.
  4. Division of Allergy and Clinical Immunology, W. G. (Bill) Hefner Veterans Affairs Medical Center, Salisbury, NC, USA.

PMID: 28725311 PMCID: PMC5505289 DOI: 10.14740/gr824w

Abstract

A 71-year-old female with no history of liver disease or antibiotic allergy developed jaundice with elevated liver enzymes and eosinophilia following treatment with nafcillin for septic arthritis. Further workup demonstrated hepatocellular dysfunction and liver biopsy showed expansion of portal tracts by lymphocytes and eosinophils consistent with a hypersensitivity reaction. Nafcillin and related antibiotics were withdrawn, and her symptoms resolved 3 months later. We searched PubMed using terms of "nafcillin cholestasis" and "nafcillin hepatitis", and a review of the literature showed other reports of nafcillin-induced hepatitis and cholestasis. Avoidance and on occasion the guarded use of glucocorticoids can lead to recovery from the insult. This case report shows that while rare, nafcillin can cause cholestatic hepatitis through a likely eosinophil-mediated hypersensitivity reaction. Further studies are needed to elucidate the mechanism of this reaction.

Keywords: Allergy; Cholestasis; Hepatitis; Jaundice; Nafcillin

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