In order to predict and treat DILI, the detailed mechanisms underlying its development must be clarified. However, the pathogenesis of DILI remains unclear because the diagnosis is usually retrospective. A subset of patients with DILI present with clinical findings associated with allergic reactions, such as rashes or eosinophilia.[2] These reactions in patients with DILI are associated with several cytokines.[3, 4] Therefore, cytokine interactions may play an important role in the pathogenesis of DILI. A50-YEAR-OLD MAN who was being treated for type 2 diabetes mellitus and alcoholic liver injury with insulin by a general physician visited

our department complaining of dyspnea and pyrexia. Moist rales were detected in the left lower lung. Cardiac and abdominal examinations were unremarkable. The laboratory data revealed leukocytosis, liver RNA Synthesis inhibitor injury and hyperbilirubinemia: white blood cell (WBC) count, 14700/mL; alanine aminotransferase (ALT), 225 IU/L; and γ-glutamyl transpeptidase (γ-GTP), 1090 IU/L. Chest radiography revealed an infiltrative shadow accompanied by

an air bronchogram in the right upper lobe. The patient was diagnosed with alcoholic liver injury and pneumonia. The pneumonia was treated with several antibiotics: tazobactam/piperacillin (TAZ/PIPC, 9 g/day) from the first hospital day to the seventh hospital day, micafungin (MCFG, 75 mg/day) from the eighth hospital day to selleck inhibitor the 17th hospital day and levofloxacin (LVFX, 500 mg/day) from the eighth hospital day to the 17th hospital day. On the 15th hospital day, the pneumonia improved and the liver enzyme level

returned to normal. However, the patient complained of right upper abdominal distention on the 16th hospital day. 上海皓元 Although this symptom rapidly disappeared after 4 h, asymptomatic liver injury was detected on the 17th hospital day: ALT, 666 IU/L; γ-GTP, 621 IU/L; and alkaline phosphatase, 2113 IU/L (Fig. 1 and Table 1). No causes of acute liver injury, such as cholelithiasis, viral infection or autoimmune disease, were detected (Supporting Information Fig. S1). Therefore, a diagnosis of DILI due to antibiotics was suspected, and all medications were discontinued, except for insulin. The liver enzyme elevation improved by the 22nd hospital day without specific therapy, and the patient was discharged on the 26th hospital day. Although drug-induced lymphocyte stimulation test (DLST) was performed for TAZ/PIPC, MCFG and LVFX, DLST for all these medicines was negative. The Roussel Uclaf Causality Assessment Method score in this case was 10 and the Japan Digestive Disease Week score was 9 (Table 2). According to the patient’s clinical course, the antibiotics were considered to be the causal drugs (Fig. 1). Serum samples were collected on the 15th hospital day, when the serum liver enzyme levels were within the normal limits, and it was 2 days before marked elevation in the liver enzymes levels was observed.