Drug-Induced Liver Injury with Commonly Used Antibiotics in the All of Us Research Program.

Antibiotics are a known cause of idiosyncratic drug-induced liver injury (DILI). According to the Centers for Disease Control and Prevention, the five most commonly prescribed antibiotics in the United States are azithromycin, ciprofloxacin, cephalexin, amoxicillin, and amoxicillin-clavulanate. We quantified the frequency of acute DILI for these common antibiotics in the All of Us Research Program, one of the largest electronic health record (EHR)-linked research cohorts in the United States. Retrospective analyses were conducted applying a standardized phenotyping algorithm to de-identified clinical data available in the All of Us database for 318,598 study participants. Between February 1984 and December 2022, more than 30% of All of Us participants (n = 119,812 individuals) had been exposed to at least 1 of our 5 study drugs. Initial screening identified 591 potential case patients that met our preselected laboratory-based phenotyping criteria. Because DILI is a diagnosis of exclusion, we then used phenome scanning to narrow the case counts by (i) scanning all EHRs to identify all alternative diagnostic explanations for the laboratory abnormalities, and (ii) leveraging International Classification of Disease 9th revision (ICD)-9 and ICD 10th revision (ICD)-10 codes as exclusion criteria to eliminate misclassification. Our final case counts were 30 DILI cases with amoxicillin-clavulanate, 24 cases with azithromycin, 24 cases with ciprofloxacin, 22 cases with amoxicillin alone, and < 20 cases with cephalexin. These findings demonstrate that data from EHR-linked research cohorts can be efficiently mined to identify DILI cases related to the use of common antibiotics.

Hepatic Lymphangitic Carcinomatosis from Esophageal Adenocarcinoma - First Case Report.

A male patient with metastatic esophageal adenocarcinoma presented with acute worsening of the liver test abnormalities. He had no infection symptoms or exposure to medication that can cause it. MRI showed findings of cholangitis, and liver biopsy revealed malignant cell infiltration in the lymphatics and cholestasis. Based on the literature search, this will be the first case report of lymphangitic carcinomatosis involving the liver from esophageal cancer.

Not All Hepatocellular Adenomas are Caused by the Hormonal Oral Contraceptive.

This is a case report of a female patient with multiple hepatocellular adenomas secondary to the glycogen storage disease 1a with asymptomatic and late adult-onset presentation. Even though the patient was taking a hormonal oral contraceptive, it was important to identify the genetic disorder and ensure adequate metabolic control which is considered a modifier of the adenoma formation and progression. It is also imperative that the patient gets monitored for the adenoma-to-hepatocellular carcinoma transformation.

Review of Medical Management of Primary Biliary Cholangitis.

Primary biliary cholangitis (PBC) is a chronic cholestatic liver disease with presumed autoimmune etiology. Current treatment options include ursodeoxycholic acid, obeticholic acid, and fibrate, which target mainly cholestasis. There is no effective therapy against autoimmune or hepatic fibrosis components. We can still achieve adequate biochemical response with monotherapy or a combination of medications in non-cirrhotic and compensated cirrhotic PBC patients. Several criteria are available for risk stratification and assess treatment response. Liver stiffness measurement by transient elastography is also a useful tool for evaluating disease progression. Lack of treatment or inadequate response are predictors of poor outcome. There is a strong need for additional therapies for PBC.

Autoimmune Hepatitis Associated with COVID-19 Infection - A Diagnostic and Therapeutic Dilemma.

Severe acute respiratory syndrome coronavirus (SARS-CoV-2) is the causative virus of the COVID-19 (coronavirus disease 2019) pandemic. Hepatic involvement is widely reported, and there are many proposed causes of liver injury in this setting. We present a patient who developed autoimmune hepatitis in association with the COVID-19 infection, which created a diagnostic and therapeutic dilemma.

Iatrogenic hepatic pneumovenogram.

Accidental air entry during central venous catheterization is a preventable iatrogenic complication that can cause venous air embolism (VAE). Many cases of VAE are subclinical with no adverse outcome and thus go unreported. Usually, when symptoms are present, they are nonspecific, and a high index of clinical suspicion of possible VAE is required to prompt investigations and initiate appropriate therapy. Occasionally large embolism can lead to life-threatening acute cor pulmonale, asystole, sudden death, and arterial air embolism in the presence of shunt or patent foramen ovale. This paper discusses VAE during emergency central line placement and the diagnostic dilemma that it can be created in critically ill patients. All necessary precautions have to be strictly followed to prevent this iatrogenic complication.

A case of acute paraplegia that improved with dialysis.

Acute severe hyperkalemia can present as acute paraplegia independent of cardiac effects, even though cardiac muscle is more sensitive to serum potassium changes. We managed a patient with acute hyperkalemic paralysis who did not have threatening cardiac/electrocardiographic manifestations. The limb weakness became normal after hemodialysis.