Attached
Background: Cefuroxime very rarely causes drug-induced liver injury. We present a case of a patient with
paradoxical worsening of jaundice caused by cefuroxime-induced cholestasis following therapeutic endoscopic
retrograde cholangiopancreatography for a distal common bile duct stone.
Case presentation: A 51-year-old, previously healthy Sri Lankan man presented to our hospital with obstructive
jaundice caused by a distal common bile duct stone. Endoscopic retrograde cholangiopancreatography with stone
extraction, common bile duct clearance, and stenting failed to improve the cholestasis, with paradoxical worsening
of his jaundice. A liver biopsy revealed features of drug-induced intrahepatic cholestasis. Although his case was
complicated by an episode of cholangitis, the patient made a complete recovery in 4 months with supportive
treatment and withdrawal of the offending drug.
Conclusions: This case highlights a very rare drug-induced liver injury caused by cefuroxime as well as our
approach to treating a patient with paradoxical worsening of jaundice after therapeutic endoscopic retrograde
cholangiopancreatography
