Faragalla Kyrillos, Cohen-Lyons Daniel, Parvinnejad Nikoo, Wang Hanlin L, Liu Jimin
Internal Medicine, University of Saskatchewan, Saskatoon, Ontario, Canada.
Gastroenterology, Mackenzie Health, Richmond Hill, Ontario, Canada.
Can Liver J. 2024 Aug 28;7(3):377-382. doi: 10.3138/canlivj-2024-0001. eCollection 2024 Aug.
Fosfomycin is an antibiotic often used to treat urinary tract infections (UTIs) with only rare transient hepatotoxicity. We present a case of fosfomycin-induced liver injury and describe the histopathologic findings on biopsy.
A 64-year-old female patient with no prior liver disease or risk factors was started on fosfomycin as prophylaxis for recurrent UTIs. Within a week of her first dose, she presented with fatigue, jaundice, and mixed liver enzyme elevation. Clinical workup for acute liver injury was unremarkable, and biopsy showed panacinar and portal necroinflammation with predominantly lymphocytic infiltrate and cholestasis, with no evidence of cirrhosis. This was thought to be likely related to fosfomycin exposure. Although liver enzymes trended down, bilirubin initially remained elevated. However, within 3 months the patient achieved clinical and biochemical recovery.
Only two other reports of fosfomycin-induced liver injury requiring biopsy were found. Both developed acute cholestatic hepatitis within days of exposure, and subsequent biopsy similarly showed lymphocytic necroinflammation. Although one patient initially developed acute liver failure, both recovered fully within a few months.
Overall, these cases suggest potentially an idiosyncratic or immune-mediated liver toxicity of Fosfomycin, which is typically self-limited but may take months to fully resolve. Liver biopsy may be useful in confirming the diagnosis.
磷霉素是一种常用于治疗尿路感染（UTIs）的抗生素，仅有罕见的短暂肝毒性。我们报告一例磷霉素所致肝损伤病例，并描述活检的组织病理学发现。
一名64岁女性患者，既往无肝病或危险因素，开始使用磷霉素预防复发性尿路感染。在首次用药一周内，她出现疲劳、黄疸及混合性肝酶升高。急性肝损伤的临床检查无异常，活检显示全小叶和门脉区坏死性炎症，主要为淋巴细胞浸润及胆汁淤积，无肝硬化证据。这被认为可能与接触磷霉素有关。尽管肝酶呈下降趋势，但胆红素最初仍升高。然而，3个月内患者实现了临床和生化恢复。
仅发现另外两篇关于磷霉素所致肝损伤需活检的报告。两者均在接触磷霉素数天内发生急性胆汁淤积性肝炎，随后活检同样显示淋巴细胞坏死性炎症。尽管一名患者最初发生急性肝衰竭，但两人均在数月内完全康复。
总体而言，这些病例提示磷霉素可能存在特异质性或免疫介导的肝毒性，通常为自限性，但可能需要数月才能完全恢复。肝活检可能有助于确诊。
