SHM Converge Scientific Abstract ePoster Gallery-A Hidden Culprit: A Rare Case of Daptomycin Associated Hepatotoxicity

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This case report describes a 71-year-old man with CKD, CAD, BPH, atrial fibrillation, and diabetes who was hospitalized for a left foot MRSA infection after failed outpatient antibiotics. He was started on piperacillin-tazobactam (Zosyn) and daptomycin, improved clinically, but then developed rapidly worsening liver injury.<br /><br />His liver enzymes were initially normal, then rose sharply by hospital day 6, with nausea and mild abdominal pain. After a toe amputation under general anesthesia, daptomycin and metronidazole were restarted but quickly stopped again because liver tests continued to rise. He then became confused and jaundiced, with transaminases peaking in the 5000s and INR reaching 9.3, consistent with acute liver failure and hepatic encephalopathy. Rifaximin and lactulose were started, and both mental status and liver enzymes later improved.<br /><br />Extensive workup did not support viral hepatitis, autoimmune hepatitis, or another clear infectious cause. Although ischemic injury related to anesthesia and other drugs was considered, the timing suggested drug-induced liver injury (DILI). Zosyn was also suspected because liver enzymes began to decrease after it was discontinued. Daptomycin has only a few reported cases of hepatotoxicity, often linked to rhabdomyolysis, but it remains a possible cause.<br /><br />The main takeaway is that DILI should be considered in patients with polypharmacy, even when medications are thought to have low hepatotoxic risk. Prompt recognition and stopping the offending agent(s) may prevent progression to severe liver injury or acute liver failure.

Asset Subtitle

Anhthu Trinh

Meta Tag

Author List Anhthu Trinh, Atul Singh

Category Clinical Vignettes

Concept Drug-Induced Liver Injury

Concept Aminotransferase Elevation

Concept Hepatotoxicity

Concept Polypharmacy

Concept Viral Hepatitis

Distinguished Non-Finalist

Presenter Organization WVU School of Medicine

Presenting Author Anhthu Trinh

Track Adult

Keywords

drug-induced liver injury

acute liver failure

daptomycin

piperacillin-tazobactam

MRSA infection

hepatic encephalopathy

transaminase elevation

jaundice

polypharmacy

hepatotoxicity

Drug-Induced Liver Injury

Aminotransferase Elevation

Hepatotoxicity

Polypharmacy

Viral Hepatitis