Idiosyncratic Drug Induced Liver Injury Secondary to Ciprofloxacin: A Reminder to Always Check Medication History

A 38-year-old Caucasian male with no significant past medical history presented to the emergency department with complaints of nausea, vomiting, abdominal pain, and jaundice of 2 days duration. He noticed this in addition to pruritus, fever, and malaise. He had severe transaminitis and hyperbilirubinemia on laboratory evaluation. He was admitted for acute liver injury of an unknown etiology. He had taken a course of ciprofloxacin days prior to presentation for UTI at an outlying facility. Serologies were also concerning possible autoimmune liver disease with elevated Anti-Nuclear Antibody and equivocal Anti Smooth Muscle Antibody. Liver biopsy was negative for any autoimmune pathology. It was determined that the patient experience Drug Induced Liver Injury (DILI) secondary to Ciprofloxacin. Although previously perceived to be a rare occurrence, providers should be aware of the possibility of DILI when prescribing Ciprofloxacin.