Levofloxacin-Induced Hepatotoxicity and Death Muge Gulen, MD, 1 Mehmet Oguzhan Ay, MD, 2 * Akkan Avci, MD, 2 Ayca Acikalin, MD, 3 and Ferhat Icme, MD 4 Drug-induced hepatotoxicity is a major cause of hepatocellular injury in patients admitting to emergency services with acute liver failure. Hepatic necrosis may be at varying degrees from mild elevations in transaminases to fulminant hepatitis, and even death. The case of a 53-year-old female patient with toxic hepatitis due to levofloxacin and multiple organ failure secondary to toxic hepatitis is presented. Patient suffered itching, redness, and rash after receiving a single dose of 750 mg of levofloxacin tablets for pulmonary infection 10 days ago. Skin lesions had regressed within 3 days, but desquamation formed all over the body. After the fifth day of drug intake, complaints of abdominal pain, vomiting, and yellowing in skin color had started. The patient was referred to our emergency department with these complaints 10 days after drug intake. Patient was thought as a candidate for liver transplant, but cardiopulmonary arrest occurred, and the patient died before she could be referred to a transplant center. This case is important because hepatotoxicity and death due to levofloxacin is uncommon in the literature. Keywords: levofloxacin, hepatotoxicity, multiple organ failure INTRODUCTION Acute hepatic failure (AHF) is a clinical syndrome that may be potentially reversible, but with a high mortality rate characterized by a sudden complete or near-complete loss of liver functions without any previous liver disease and accompanied by hepatic encephalopathy. 1 Drug-induced hepatotoxicity is a major cause of hepatocellular injury in patients admitting to emer- gency services with acute liver failure. Hepatic necro- sis may be at varying degrees from mild elevations in transaminases to fulminant hepatitis, and even death. 2 In this case, we aimed to examine a 53-year-old female patient with toxic hepatitis that developed after intake of a single dose of levofloxacin due to lower respiratory tract infection and resulted in death in the light of the recent literature. CASE REPORT A 53-year-old female patient was referred to our emer- gency department with confusion, abdominal pain, jaun- dice, and impairment of liver function tests. The patient was confused and her Glasgow Coma Scale was 12 (E3, V4, M5) at admission. Her vital signs were as follows: arterial blood pressure was 90/60 mm Hg, heart rate 110/min, body temperature 36.7°C, and respiratory rate 35/min. As the patient was confused, her measured bed- side blood glucose level was 53 mg/dL. The skin was all covered with squamous lesions, and the skin and sclera were icteric. There were generalized edema around the eyes, widespread ecchymotic areas on arms, and pete- chiae on the tibia surface. At cardiac examination, the heart was rhythmic and tachycardic. There were no addi- tional sound and murmur. The patient was dyspneic and tachypneic. There were basilar crepitant crackles in bilat- eral lungs. She had abdominal tenderness, but spleen and liver were not palpable. Traube space was open. 1 Emergency Medicine Service, Eskisehir Yunus Emre State Hospital, Eskisehir, Turkey; 2 Department of Emergency Medicine, Adana Numune Education and Research Hospital, Adana, Turkey; 3 Depart- ment of Emergency Medicine, School of Medicine, Cukurova University, Adana, Turkey; and 4 Department of Emergency Medi- cine, Ataturk Education and Research Hospital, Ankara, Turkey. The authors have no conflicts of interest to declare. *Address for correspondence: Department of Emergency Medi- cine, Adana Numune Education and Research Hospital, Ege Bagatur Boulevard, Yuregir, 01240 Adana, Turkey. E-mail: droguzhan2006@mynet.com American Journal of Therapeutics 22, e93–e96 (2015) 1075–2765 Copyright Ó 2013 Wolters Kluwer Health, Inc. All rights reserved. www.americantherapeutics.com Copyright © 201 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. 5