tients had elevated liver enzymes. We describe a man who developed reversible eosinophilic hepatitis after two weeks of treatment of community-acquired pneumonia with cefonicid.Case Report. A 67-year-old white man was referred to the Internal Medicine Department for evaluation of hepatitis. Results of liver function tests performed two months earlier were normal, and his previous medical history was unremarkable. The patient did not drink alcohol and had no known exposure to hepatotoxins or parenterally transmitted viruses. There was no family history of liver disease. He was not using over-the-counter medications or herbal medicines and had no history of allergy to any medication.The patient had a 20-day history of a cough productive of yellowish sputum, with low-grade fever, asthma, and generalized malaise. A chest X-ray showed a small consolidation in the right lower lobe; treatment was begun with intramuscular cefonicid 1 g/d and inhalation aerosol with salmeterol xinafoate and fluticasone propionate. After one week of cefonicid therapy, the patient reported improved pulmonary symptoms, but not complete recovery. At that time, a transient, itchy, erythematous, papular rash was observed on his chest, forehead, and back. The rash promptly subsided after a single dose of diphenhydramine 25 mg. Treatment with cefonicid, salmeterol, and fluticasone was continued. Seven days later, the patient was seen in the emergency department reporting anorexia, nausea, vomiting, fatigue, and abdominal discomfort.On physical examination, the patient was afebrile, anicteric, fully alert, and had no cutaneous stigmata of chronic liver disease. The abdomen was diffusely tender, with no rebound tenderness and no evidence of organomegaly or ascites. Flapping tremor was absent. Laboratory results included a serum aspartate transaminase (AST) concentration of 160 U/L (normal range 10-36), an alanine transaminase (ALT) concentration of 312 U/L (6-40), a γ-glutamyl transferase (GGT) concentration of 453 U/L (7-49), and an alkaline phosphatase (AP) concentration of 563 U/L (91-258). Serum bilirubin was normal, and albumin concentration was 3.2 g/L. Laboratory evaluation did not reveal evidence of viral, metabolic, or autoimmune liver disease. Peripheral eosinophilia was observed (percentage of eosinophils was as high as 22% on repeated determination), with an absolute count of 700 cells/mm. 3 Abdominal ultrasonography showed an enlarged liver with a normal gallbladder and pancreas. Computed tomography of the abdomen was consistent with a fatty liver, and there was no evidence of biliary obstruction. A liver biopsy was not done.Cefonicid therapy was discontinued and the symptoms gradually improved, with complete resolution after four days. Serum enzyme concentrations and the absolute eosinophil count decreased rapidly, although they remained elevated throughout the eight days of hospitalization. At no time were signs or symptoms of hepatic failure observed. The patient did not consent to a rechallenge test.Because of the gradual decline i...
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