Fluoroquinolone-induced liver injury: A case report and literature review

Abstract

Fluoroquinolones are commonly prescribed antibiotics known for their broad-spectrum coverage and high oral bioavailability. While generally well-tolerated, they have been associated with rare but potentially serious adverse effects, including drug-induced liver injury (DILI). We report the case of a 31-year-old female with a history of intravenous drug use and chronic hepatitis C who developed acute liver injury shortly after completing a course of ciprofloxacin for cystitis. She presented with jaundice, right upper quadrant abdominal pain, and markedly elevated liver enzymes. An extensive workup for alternative etiologies, including viral, autoimmune, and metabolic liver diseases, was unremarkable. Clinical improvement and a steady decline in transaminases were observed following the discontinuation of ciprofloxacin, supporting the diagnosis of fluoroquinolone-induced hepatocellular injury. This case underscores the diagnostic challenge of DILI, particularly in patients with underlying hepatic conditions. The proposed mechanisms of injury include the inflammatory stress hypothesis and the danger hypothesis, both of which may have been relevant in this patient given her chronic hepatitis C and recent infection. Although rare, fluoroquinolone-induced DILI should be considered in the differential diagnosis of acute liver injury, especially when other causes have been excluded. Early recognition and cessation of the offending agent remain critical to avoid progression to fulminant liver failure.