左氧氟沙星致严重肝损害

Severe liver damage caused by levofloxacin

1例76岁女性患者,行白内障手术后口服左氧氟沙星0.2g,2次/d治疗5d,并以左氧氟沙星滴眼液滴眼1周。用药2周后患者出现乏力,皮肤、巩膜黄染,尿黄,腹胀,食欲下降。实验室检查显示:ALT1645U/L,AST885U/L,γ-GT198U/L,ALP155U/L,TBil68.9μmol/L,DBil42.8μmol/L,IBil26.1μmol/L,ALB33.9g/L,APTT41.8s。患者既往无肝病史。肝炎病毒及巨细胞病毒、EB病毒、风疹病毒、柯萨奇病毒的IgM阴性,抗核抗体、抗线粒体抗体等均阴性,可排除其他原因所致肝损害。给予还原型谷胱苷肽、熊去氧胆酸、茵栀黄注射液及复合维生素B等治疗3周,黄疸明显消退,复查肝功能:ALT51U/L,AST33U/L,γ-GT79U/L,ALP102U/L,TBil19.2μmol/L,DBil5.8μmol/L,IBil13.2μmol/L,ALB42.1g/L。

A 76-year-old woman was administered with of oral levofloxacin O. 2 g twice daily for 5 days and levofloxacin eye drops for 1 week after undergoing cataract extraction. Two weeks later, the woman presented with asthenia, jaundiced skin and sclera, dark urine, abdominal distension, and anorexia. Laboratory investigations revealed the following levels： ALT 1 645 U/L, AST 885 U/L, γ-GT 198 U/L, ALP 155 U/L,TBil 68.9 μmoL/L, DBil 42.8 μmol/L,IBil 26.1 μmol/L, ALB 33.9 g/L, APTT 41.8 s. She had no history of liver disease previously. Serological tests for hepatitis virus, cytomegalovirus, EB virus, rubella virus, and IgM of Coxsackie virus were negative; serological tests for antinuelear antibody and anti-mitochondrial antibody were negative. Other causes of liver damage were excluded. After 3 weeks of treatment with reduced glutathione, ursodesoxycholic acid, Yinzhihuang injection, and vitamin B complex, her jaundice markedly subsided and liver function tests showed the following： ALT 51 U/L, AST 33 U/L, γ-GT 79 U/L, ALP 102 U/L,TBil 19.2μmol/L,DBil 5.8 μmol/L,IBil 13.2 μmol/L,ALB 42. 1g/L.