Ciprofloxacin-Induced Hepatocellular Injury in an Elderly Patient With Polypharmacy and Multiple Comorbidities

Ciprofloxacin is a widely prescribed fluoroquinolone antibiotic that may cause transient aminotransferase elevations, although clinically significant drug-induced liver injury remains rare. We present a 72-year-old woman with multiple comorbidities who developed worsening transaminitis shortly after ciprofloxacin initiation for a urinary tract infection. The patient was recently hospitalized for rhabdomyolysis-associated acute kidney injury with improving liver enzymes prior to antibiotic exposure. After four doses of ciprofloxacin, alanine aminotransferase and aspartate aminotransferase increased, while bilirubin remained normal. Given the temporal association and absence of alternative hepatic pathology, ciprofloxacin-induced hepatocellular injury was suspected. Discontinuation of the medication resulted in prompt improvement in liver enzymes. This case highlights the importance of recognizing ciprofloxacin-associated hepatotoxicity, particularly in medically complex patients, and emphasizes early discontinuation to prevent progression of liver injury.