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Semin Liver Dis 2002; 22(2): 207-210
DOI: 10.1055/s-2002-30107
DIAGNOSTIC PROBLEMS IN HEPATOLOGY

Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

A 33-Year-Old Woman with Jaundice after Azithromycin Use

Arief Suriawinata1 , Albert D. Min2
  • 1Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
  • 2Division of Liver Diseases, Department of Medicine, Mount Sinai School of Medicine, New York, New York
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Publication History

Publication Date:
16 May 2002 (online)

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CASE REPORT

A 33-year-old woman presented with a history of migraine, and a flu-like syndrome for which she had taken a 5-day course of azithromycin followed by one day of erythromycin. She began to have dark urine and pruritus, and 3 days later, her friend noticed her to be jaundiced. Three additional days later, she presented to her primary care physician with jaundice. Her laboratory results included total and direct bilirubinof 11.3/6.8 mg/dL (normal = 0.1-1.2/0.0-0.8), alanine aminotransferase (ALT) of 583 U/L (normal = 1-53), aspartate aminotransferase (AST) of 208 U/L (normal = 1-50). She had been taking propranolol for 1 year, sumatriptan for 6 months and oral contraceptive steroids on-and-off for 15 years and for about 1 year prior to this presentation. All medications were stopped. Over the next 3 weeks, her pruritus worsened with total bilirubin of 25 mg/dL.

She presented to the Mount Sinai Hospital for further management after trying cholestyramine without any relief. Review of her prior work-ups, which included ultrasound and CT scan, showed no dilatation of bile ducts. There was no history of blood transfusion or intravenous drug use. She had about one drink of alcohol per month. She worked as a computer database person. Her family history was significant for her paternal grandfather with ``liver cancer.''

On examination, she was markedly jaundiced with numerous scratch marks over her entire body, but there were no stigmata of chronic liver disease. There was no hepatosplenomegaly, ascites or pedal edema. Her blood tests at this time showed total and direct bilirubin of 22.8/20.4 mg/dL, ALT of 42 U/L, AST of 45 U/L and alkaline phosphatase of 228 U/L (normal = 20-130). The viral serologies were all negative. These included negative IgM anti-HAV, HBsAg, IgM anti-HBc, and HCV RNA by qualitative PCR. Anti-smooth muscle and anti-LKM antibodies were not detectable. Anti-nuclear antibodies were ``weakly positive,'' and serum protein electrophoresis showed normal level of gamma-globulin. Ceruloplasmin level was normal. A repeat ultrasound showed no bile duct dilatation. A liver biopsy was performed.

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