Reactions 892 - 9 Mar 2002

★ SCefonicid

First report of eosinophilic hepatitis in an elderlypatient: case report

Treatment with cefonicid for community-acquiredpneumonia was associated with the development ofeosinophilic hepatitis in a 67-year-old man.

The man had been receiving IM cefonicid 1 g/day for 1 weekwhen he reported the transient appearance of a pruritic,erythematous papular rash involving his chest, forehead andback. He had also been receiving salmeterol and fluticasonepropionate. One week later, he presented with nausea,vomiting, anorexia, fatigue and abdominal discomfort. His ASTand ALT levels were 160 U/L (normal 10–36) and 312 U/L(6–40), respectively, his γ-glutamyl transferase level was 453U/L (7–49), his alkaline phosphatase level was 563 U/l(91–258) and his peripheral eosinophil count was 700/mm3.Investigations revealed a fatty, enlarged liver.

Treatment with cefonicid was stopped, and the man’ssymptoms resolved after 4 days. At discharge on hospital day8, his liver enzyme levels and eosinophil count had decreased,and they had normalised within 7 weeks of cefoniciddiscontinuation. During 6 months’ follow-up, he remainedsymptom-free with normal liver function.

Author comment: ‘The temporal relationship in our patientlinking the institution of cefonicid therapy with thedevelopment of rash, peripheral eosinophilia, and hepatitisimplicates a hypersensitivity-like liver injury, which reflects animmune mechanism triggered by the drug.’Famularo G, et al. Eosinophillic hepatitis associated with cefonicid therapy. Annalsof Pharmacotherapy 35: 1669-1671, Dec 2001 - Italy 800900209

» Editorial comment: A search of AdisBase and Medline didnot reveal any previous case reports of hepatitis or eosinophiliaassociated with cefonicid. The WHO Adverse Drug Reactionsdatabase contained 2 reports of hepatitis, and 1 report ofeosinophilia, associated with cefonicid.

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Reactions 9 Mar 2002 No. 8920114-9954/10/0892-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved