Doxycycline/rifampicin

Abstract

Worsening of liver function and chronic liver damage: case reportA 9-year-old girl developed worsening of liver function and chronic liver damage during treatment with rifampicin and doxycycline for Brucellosis and Pseudomonas bacteraemia [routes and dosages not stated].The girl was admitted to hospital for evaluation of jaundice and fever. Subsequently, she started receiving IV fluids and empiric antibiotics for jaundice, fever and abdominal pain of unknown causation. On the third day of admission, Brucella serology was high and blood culture grew Pseudomonas aeruginosa. Thereafter, antibiotics were changed to doxycycline, cefepime and rifampicin [rifampin]. On day five of admission, she received two units of packed erythrocytes [RBC]. Total bilirubin reduced briefly after initiating antibiotics; however later on liver function continued to worsen with rising indirect bilirubin, total bilirubin, transaminases and PT/INR. The girl's treatment with rifampicin was stopped on day 14 of the admission due to worsening liver function. Thereafter, a diagnosis of Wilson's disease was confirmed. She receiving penicillamine [D-penicillamine] along with pyridoxine and zinc. Fibroscan revealed a fibrosis score of 24.4 kPa indicative of advanced liver scarring. Based on the findings, a diagnosis of worsening of liver function and chronic liver damage associated with rifampicin and doxycycline was confirmed [durations of treatments to reactions onset not stated]. After the treatment with penicillamine, liver function improved and she was discharged on day 40. Subsequently, her clinical conditions improved and normalisation of laboratory parameters primarily liver function tests were observed.