Rhabdomyolysis attributed to terbinafine: A rare occurrence that can be mistaken for terbinafine-induced hepatotoxicity

Ly, Priscilla; Subrt, Adrian; Wilkerson, Michael G.

doi:10.1016/j.jdcr.2018.08.025

Cited by 4 publications

(10 citation statements)

References 10 publications

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“…The mechanism of rhabdomyolysis in these cases is unclear, but proposed to be a drug-facilitated reaction. 11 …”

Section: Discussionmentioning

confidence: 99%

“…He had elevated liver enzymes, which could be attributed to rhabdomyolysis-induced hepatic injury, or the extensive release of AST and ALT from damaged muscle cells. [9][10][11] A concurrent terbinafine-induced hepatotoxicity cannot be ruled out, but less likely.…”

Section: Discussionmentioning

confidence: 99%

“…In the English literature, there are only a few case reports of terbinafine-induced rhabdomyolysis. [11][12][13] Ly et al reported a case of rhabdomyolysis due to terbinafine use and concurrent exercise; CK was elevated at 14 400 U/L. Bui et al described a similar case in the context of increased exercise intensity, and the CK was <5000 U/L.…”

Section: Discussionmentioning

confidence: 99%

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RETRACTED: Rhabdomyolysis and Acute Kidney Injury Associated With Terbinafine Use: A Case Report

Zhou

Bagga

2020

Can J Kidney Health Dis

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Rationale: Terbinafine is an antimicrobial agent commonly prescribed for fungal infections. Its side effect profile is generally benign, but there is limited evidence that it has the potential to cause rhabdomyolysis. Rhabdomyolysis is a potentially life-threatening condition caused by profound muscle injury. It has characteristic findings of muscle pain, weakness, and dark urine. When recognized early, patients with rhabdomyolysis can be managed conservatively with hydration and watchful monitoring. However, if treatments are delayed, or in severe cases of rhabdomyolysis, complications such as electrolyte abnormalities, acute kidney injury, and disseminated intravascular coagulation can develop. Presenting concerns of the patient: A previously healthy 22-year-old male presented with nausea, vomiting, and dark urine after taking terbinafine 250 mg daily for a tinea infection for 9 days. He developed severe rhabdomyolysis with a serum creatine kinase (CK) of >100 000 U/L as well as anuric acute kidney injury. Diagnosis: The clinical history combined with the diagnostic findings suggest acute kidney injury and rhabdomyolysis associated with terbinafine use. Interventions: Terbinafine use was stopped immediately. The patient was started on intravenous fluids and bicarbonate drip. Hemodialysis was initiated to prevent further complications. After his CK level decreased and his clinical status stabilized, he was discharged home and continued to receive outpatient hemodialysis treatments. Outcome: The patient’s kidney function returned to baseline after 1 month of outpatient hemodialysis treatments. Novel finding: In this report, we present a case of rhabdomyolysis associated with terbinafine use that progressed to acute kidney injury requiring dialysis. Our case highlights a less known and severe side effect of this medication and emphasizes the importance of early recognition and treatment of rhabdomyolysis.

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“…The mechanism of rhabdomyolysis in these cases is unclear, but proposed to be a drug-facilitated reaction. 11 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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RETRACTED: Rhabdomyolysis and Acute Kidney Injury Associated With Terbinafine Use: A Case Report

Zhou

Bagga

2020

Can J Kidney Health Dis

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“…1, 2 Terbinafine-induced myalgia and rhabdomyolysis have been observed in post-marketing surveillance studies; however, there are no reports of myositis. 3, 4 We report a case of terbinafine-induced myositis in a 37-year-old Asian male patient treated for Tinea cruris.…”

Section: Introductionmentioning

confidence: 99%

Terbinafine-induced Myositis: A Case Report

Shariff,

Shetty,

Singh

et al. 2023

Journal of Pharmacology and Pharmacotherapeutics

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We report a case of terbinafine-induced myositis in a 37-year-old Asian male patient treated for Tinea cruris. The patient complained of severe generalized body aches, weakness, fever, fatigue, and passing of concentrated urine after consuming one dose of terbinafine 250 mg tablet, which worsened after the second dose. At the presentation, the patient was afebrile, fatigued, and had difficulty moving. All the laboratory parameters were normal, except N-acetyl-cysteine-(NAC)-activated creatine kinase, which was elevated to 276 U/L. There was a slight elevation in alanine transaminase (ALT) levels (44 U/L) and albumin-to-globulin ratio (1.8). The oral terbinafine was stopped. Patient was prescribed with tablet acetaminophen 650 mg thrice daily for two days and as needed thereafter, to manage myalgia. The patient reported being symptomatically better after six days of terbinafine withdrawal. The Naranjo’s causality assessment scale score was eight, indicating a probable relation between drug exposure (terbinafine use) and adverse drug reaction (myositis). The severity of terbinafine-induced myositis in this patient was moderate (level 3) as categorized by the Modified Hartwig and Siegel scale.

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“…Terbinafine is an orally and topically active allylamine antifungal agent that is used to treat superficial infections of the skin and nails [ 1 ]. Terbinafine is a fungicidal agent that, when given orally, is the first-line treatment against mild-to-moderate dermatophyte onychomycosis [ 2 ]. Terbinafine works through selective inhibition of fungal squalene epoxidase, raising levels of squalene to toxic levels and thus eliminating the infection [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Drug-Induced Liver Injury Secondary to Terbinafine Use

Brown,

Potesta,

Hameed

2024

Cureus

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Drug-induced liver injury (DILI) has a symptomatic profile that mimics many forms of hepatic injury. In patients presenting with symptoms suspicious of acute liver injury, it is important that clinicians effectively rule out more common causes while simultaneously maintaining a broad differential diagnosis that includes DILI. In this report, we present the case of a 41-year-old African American male who was admitted to the hospital for two weeks’ duration of worsening jaundice, right upper quadrant pain, pruritus, and acholic stools after terbinafine use for an acute episode of onychomycosis. Physical examination showed evidence of jaundice, scleral icterus, and a soft non-distended abdomen. Initial laboratory results at admission showed significant elevation of total bilirubin, alkaline phosphatase, aspartate aminotransferase, and alanine aminotransferase. Careful review of the patient’s medications, a clinical workup to rule out primary causes of hepatobiliary pathology, and confirmatory liver biopsy showing benign hepatic parenchyma with marked cholestasis including bile plugs and bile granulomas provided sufficient evidence supporting terbinafine use as the inciting factor. The emphasis of this case is to highlight the symptoms, diagnostic measures, and suspected pathophysiology of terbinafine-induced hepatotoxicity.

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Rhabdomyolysis attributed to terbinafine: A rare occurrence that can be mistaken for terbinafine-induced hepatotoxicity

Cited by 4 publications

References 10 publications

RETRACTED: Rhabdomyolysis and Acute Kidney Injury Associated With Terbinafine Use: A Case Report

RETRACTED: Rhabdomyolysis and Acute Kidney Injury Associated With Terbinafine Use: A Case Report

Terbinafine-induced Myositis: A Case Report

Drug-Induced Liver Injury Secondary to Terbinafine Use

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