P1128 - Unveiling the Uncommon: Co-Occurrence of Drug-Induced Liver Injury and Erythema Multiforme Following Cefazolin Administration

Muhammad Ali Butt, MD¹, Sameen Aamer, MD², Taimur S. Muzammil, MD³, Usman Tariq, MD², Rachel Toney, MD^3
1Medicine Institute, Allegheny Health Network, Pittsburgh, PA; ²Allegheny General Hospital, Pittsburgh, PA; ³Allegheny Health Network, Pittsburgh, PA

Introduction: Adverse drug reactions can present as allergies, anaphylaxis, skin rashes, liver/kidney damage, and gastrointestinal problems. Erythema multiforme (EM) and Drug induced Liver injury (DILI) are important manifestations of adverse drug reactions. We present a unique case of co-occurrence of EM and liver injury after antibiotic administration.

Case Description/Methods: A 21-year-old female presented to our hospital with a worsening pruritic rash. Patient initially presented to an outside hospital with nausea, vomiting, and fever, where she was found to have elevated liver function tests and cholelithiasis on imaging. She underwent cholecystectomy and was discharged home on postoperative day 1. On the fifth day after surgery, she presented to the hospital with a rash involving multiple parts of her body. She denied any use of over-the-counter medications, supplements, or drugs. Patient did not have any personal or family history of liver, pancreas, or gallbladder disease except for the recent cholecystectomy. On admission, the patient was vitally stable. Her physical exam was notable for a macular erythematous rash involving the face, chest, abdomen, and bilateral upper and lower extremities. Patient had a normal complete blood count and basic metabolic panel but her LFTs were markedly elevated. A skin biopsy was performed which revealed erythema multiforme. A liver biopsy later confirmed drug-induced liver injury, this was thought to be secondary to Cefazolin which was administered before the cholecystectomy. The patient's rash improved with symptomatic treatment and liver function tests trended down over the course of hospitalization.She was subsequently discharged home in a stable condition.

Discussion: EM and DILI occurring simultaneously after cefazolin administration, is a rare event that hasn't been reported before. This case highlights the possibility of patients developing multiorgan involvement with adverse drug reactions. Recognition of such adverse effects is important for timely diagnosis, management, and prevention of unnecessary testing, invasive procedures and their associated complications.




Disclosures:


Muhammad Ali Butt, MD¹, Sameen Aamer, MD², Taimur S. Muzammil, MD³, Usman Tariq, MD², Rachel Toney, MD³. P1128 - Unveiling the Uncommon: Co-Occurrence of Drug-Induced Liver Injury and Erythema Multiforme Following Cefazolin Administration, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.