<![CDATA[Drug-induced liver injury (DILI) remains a challenge in clinical practice and is still a diagnosis of exclusion. Although it has a low incidence amongst the general population, DILI accounts for most cases of acute liver failure with a fatality rate of up to 50%. Case : A 56-year-old male was transferred to the Intensive Care Unit (ICU) with fever and severe thrombocytopenia,17,000. The patient was diagnosed with suspected sepsis and potential disseminated intravascular coagulation (DIC). Consequently, the patient was put on cefepime, administered 2g three times daily for over 30 minutes, and combined with amikacin at 1500 mg to be infused over 60 minutes. We adjusted the pharmacokinetics of cefepime on day three by changing the administration time from a 30-minute infusion to a 4-hour infusion. We discontinued amikacin on day five and continued cefepime. On day seven, the patient looked jaundiced at the sclera and skin. Upon drug chart review, we discovered that cefepime was associated with jaundice, according to post-marketing data. We ceased cefepime and ordered a Liver Function Test (LFT). The LFT results showed total bilirubin of 12 mg/dL and alkaline phosphatase nearly 1.5 times the normal level. Using the RUCAM score, the cholestatic injury was classified as mixed type with an R score of 4. Three days after discontinuing cefepime, serum total bilirubin and direct bilirubin levels decreased to 10.2 and 6.8 mg/dL, respectively. By day 25, the total bilirubin and alkaline phosphatase levels returned to near normal.]]>
