Zettwoch Allison D, Okobi Okelue E, Millan Mercedes, Perez Fonte Angelica, Figueroa Raphael S, Fatuki Tolulope A, De la Vega Raul J, Hernandez Borges Sergio, Diaz-Miret Miguel
Family Medicine, Larkin Community Hospital Palm Springs Campus, Hialeah, USA.
Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Miami, USA.
Cureus. 2025 Jul 21;17(7):e88419. doi: 10.7759/cureus.88419. eCollection 2025 Jul.
An 85-year-old female patient with multiple comorbidities, including Parkinson's disease, hyperthyroidism, congestive heart failure, and Alzheimer's, presented with dyspnea, weakness, and cough. She was found to have new-onset atrial fibrillation and a left frontal lobe infarct. Initially treated with levofloxacin and then azithromycin, she later developed right lung infiltrates, and ceftriaxone 2g IV daily was initiated. Within 48 hours, liver enzymes aspartate aminotransferase (AST) and alanine transaminase (ALT) rose markedly (from 11/26 to 452/415 U/L). We promptly discontinued ceftriaxone in response and considered alternative antibiotics. The multidisciplinary team opted for supportive management with daily liver function monitoring, resulting in gradual normalization of transaminases. This case highlights the importance of prompt drug discontinuation, use of structured drug-induced liver injury (DILI) assessment tools, and adherence to geriatric prescribing guidelines.
一名85岁女性患者，患有多种合并症，包括帕金森病、甲状腺功能亢进、充血性心力衰竭和阿尔茨海默病，出现呼吸困难、虚弱和咳嗽症状。她被发现患有新发房颤和左额叶梗死。最初接受左氧氟沙星治疗，后改用阿奇霉素，随后她出现右肺浸润，开始每日静脉注射2克头孢曲松。在48小时内，肝酶天冬氨酸转氨酶（AST）和丙氨酸转氨酶（ALT）显著升高（从11/26升至452/415 U/L）。我们立即停用头孢曲松，并考虑使用其他抗生素。多学科团队选择进行支持性治疗并每日监测肝功能，转氨酶逐渐恢复正常。该病例凸显了及时停药、使用结构化药物性肝损伤（DILI）评估工具以及遵循老年患者用药指南的重要性。
