Ciprofloxacin-induced acute liver injury: case report and review of literature

Annette Zimpfer1, Albert Propst2, Gregor Mikuz3, Wolfgang Vogel2, Luigi Terracciano1 and Sylvia Stadlmann3

(1) Institute of Pathology, University of Basel, Schoenbeinstrasse 40, 4003 Basel, Switzerland

(2) Department of Gastroenterology and Hepatology, University Hospital Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria

(3) Institute of Pathology, University of Innsbruck, Muellerstrasse 44, 6020 Innsbruck, Austria

Received: 18 July 2003 Accepted: 19 September 2003 Published online: 8 November 2003

Abstract Ciprofloxacin is a fluorinated quinolone antibiotic with relatively low occurrence of adverse side effects. However, increasing evidence suggests that ciprofloxacin may cause severe liver damage. Until now, 14 cases of ciprofloxacin-associated liver injuries have been reported. We describe a case of a 22-year-old male who developed hepatic failure after intake of ciprofloxacin. The patient had been treated with 2×250 mg ciprofloxacin per day. He presented with symptoms of acute liver failure 14 days later. Liver biopsy revealed extensive hepatocellular necrosis involving zones 3 and 2 of hepatic acini and a mixed inflammatory infiltration containing abundant eosinophils. Symptoms resolved after corticoidsteroid therapy. In the present paper, we report the clinico-pathological characteristics of a case of ciprofloxacin-associated acute hepatic failure and discuss the current literature.