Nikolajevic Nikola, Nikolajevic Milan, Pantic Ivana, Korica Bojan, Kotseva Magdalena, Alempijevic Tamara, Jevtic Dorde, Madrid Cristian I, Dumic Igor
Internal Medicine, University of Belgrade, Faculty of Medicine, Belgrade, SRB.
Gastroenterology and Hepatology, Clinic for Gastroenterology, University Clinical Center of Serbia, Belgrade, SRB.
Cureus. 2024 May 5;16(5):e59687. doi: 10.7759/cureus.59687. eCollection 2024 May.
Antibiotics are among the most common causes of drug-induced liver injury worldwide. Amoxicillin/clavulanic acid and nitrofurantoin are the most common culprits while tetracyclines are a rare cause of liver injury. Among tetracyclines, minocycline has been reported more frequently than doxycycline, which is an extremely rare cause of drug-induced liver injury. We present a healthy 28-year-old male patient from rural United States who was taking doxycycline for Lyme disease. After five days of therapy, he developed nausea, vomiting, fatigue, and significant transaminitis consistent with a hepatocellular pattern of liver injury. After a thorough workup which ruled out other causes such as infection, autoimmune diseases, liver malignancy, and vascular, structural, and metabolic disorders, his liver injury was attributed to doxycycline. We reached the diagnosis also by demonstrating a consistent temporal association between doxycycline intake and liver injury and the patient recovered completely with the cessation of doxycycline. Recognition of doxycycline as a cause of drug-induced liver injury should be considered in patients utilizing this antibiotic. Doxycycline, unlike minocycline, has a short latency period. Early recognition and discontinuation of doxycycline in our patient resulted in the complete resolution of symptoms and transaminitis preventing further morbidity and mortality.
抗生素是全球药物性肝损伤最常见的病因之一。阿莫西林/克拉维酸和呋喃妥因是最常见的罪魁祸首，而四环素类药物导致肝损伤的情况较为罕见。在四环素类药物中，米诺环素导致肝损伤的报道比多西环素更为常见，多西环素是药物性肝损伤极其罕见的病因。我们报告一例来自美国农村的28岁健康男性患者，他因莱姆病正在服用多西环素。治疗五天后，他出现恶心、呕吐、乏力以及与肝细胞性肝损伤模式相符的显著转氨酶升高。经过全面检查排除了其他病因，如感染、自身免疫性疾病、肝脏恶性肿瘤以及血管、结构和代谢紊乱后，他的肝损伤归因于多西环素。我们通过证明多西环素摄入与肝损伤之间存在一致的时间关联也得出了这一诊断，并且患者在停用多西环素后完全康复。对于使用这种抗生素的患者，应考虑认识到多西环素是药物性肝损伤的一个病因。与米诺环素不同，多西环素的潜伏期较短。在我们的患者中早期识别并停用多西环素导致症状和转氨酶升高完全消退，预防了进一步的发病和死亡。
