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SCOTT BOLESTA, PHARMD.,. is Assistant Professor, Department of Pharmacy Practice, Nesbitt College of Pharmacy and Nursing, Wilkes University, Wilkes-Barre, PA, and Clinical Pharmacist, Department of Pharmacy, Mercy Hospital, Scranton, PA. BRIAN P. ROSLUND, PHARMD., is Pharmacy Practice Resident, Department of Pharmacy,. Thomas Jefferson University Hospital, Philadelphia, PA.

Address correspondence to Dr. Bolesta at the Department of Pharmacy Practice, Nesbitt College of Pharmacy and Nursing, Wilkes University, 84 West South Street, Wilkes-Barre, PA 18766 (scott.bolesta{at}wilkes.edu).

Purpose. A case of mild hepatocellular injury associated with the administration of telithromycin in a patient with no risk factors for hepatotoxicity is presented. Summary. A 44-year-old man with no significant past medical history arrived at the emergency room after six days of high fever, chills, headache, neck stiffness, and back pain. Five days earlier, he visited a family medicine clinic for his symptoms and oral telithromycin 800 mg daily was prescribed for a suspected upper-respiratory-tract infection. The patient stopped taking the drug after three days due to persistent symptoms. On admission, the patient’s laboratory tests revealed an aspartate transaminase (AST) concentration of 68 units/L, an alanine transaminase (ALT) value of 155 units/L, and an erythrocyte sedimentation rate of 40 mm/hr. The patient was not taking any long-term medications, had taken only aspirin for his fever, and denied the use of alcohol and illegal drugs. The patient was admitted to the general medical unit with a diagnosis of possible viral hepatitis. His urine culture was negative, and serology tests later revealed no evidence of hepatitis A, B, or C. Ibuprofen, pantoprazole, and enoxaparin were prescribed. On hospital day 2, the patient’s AST and ALT concentrations had decreased to 50 and 110 units/L, respectively. By day 3, the patient’s symptoms had improved and he remained afebrile. His AST and ALT values had further decreased to 41 and 105 units/L, respectively. He was then diagnosed with acute viral upper-respiratory-tract infection with mild hepatotoxicity associated with telithromycin and was discharged home with orders for follow-up at the family medicine clinic. Conclusion. A patient without risk factors for hepatotoxicity developed mild elevations in hepatic transaminases after receiving telithromycin for the treatment of a suspected upper-respiratory-tract infection. Index terms: Anticoagulants; Antiinflammatory agents; Enoxaparin; Gastrointestinal drugs; Ibuprofen; Liver diseases; Macrolides; Pantoprazole; Respiratory tract infections; Telithromycin; Toxicity