ABSTRACT
Antimicrobial drugs are important causative agents in idiosyncratic drug-induced liver injury (DILI). As with idiosyncratic DILI in general, antibiotic-induced liver injury is rare but difficult to diagnose and almost impossible to predict. Diagnosis requires awareness of possible causal agents, vigilance in monitoring symptoms and sometimes biochemical tests, attention to careful history taking and establishing temporal association, and exclusion of competing etiologies. In most instances, patients with antibiotic-associated DILI recover if the offending agent is withdrawn in a timely fashion.
Subject(s)
Anti-Bacterial Agents/adverse effects , Chemical and Drug Induced Liver Injury , Humans , Risk FactorsABSTRACT
The question of whether viruses persist after apparent clearance of infection remains unanswered. Here, we describe a patient with hypogammaglobulinemia whose acute hepatitis C virus (HCV) infection appeared to resolve after receipt of interferon therapy, relapse immediately, and then clear spontaneously--only to relapse after receipt of corticosteroid therapy, and clear again, 8.5 years later. Sequencing indicated that the viruses detected during each relapse were virtually identical, with the hypervariable region 1 of E2 appearing to be monoclonal, which is typical of patients with hypogammaglobulinemia. Nonstructural 5A sequences exhibited quasispecies diversity initially but, after 8.5 years, had become monoclonal. The prolonged period of negativity for HCV RNA followed by relapse suggests that HCV may persist in apparent sustained viral responders.