Ciprofloxacin-induced Hepatotoxicity in a Healthy Young Adult

Ciprofloxacin is a broad-spectrum fluoroquinolone antibiotic that is widely used in the treatment of many common infections, including urinary tract infections (UTIs). Despite the increase in Escherichia coli resistance to ciprofloxacin, especially in the United States (US), clinicians continue to utilize the high bioavailability of this drug in urine to counter UTIs. A rare adverse effect following use of ciprofloxacin is drug-induced hepatitis. In this case report, we describe a young 29-year-old female with a previous medical history significant for pyelonephritis and ovarian cyst who presented to the emergency room with signs and symptoms suggestive of progressive liver injury for two weeks that started two days after a complete course of ciprofloxacin therapy for a UTI. An extensive workup failed to identify a particular cause for the hepatotoxicity. The associated onset of symptoms following ciprofloxacin use, the pattern of hepatic enzyme elevation coupled with abdominal pain suggestive of liver pathology, and the resolution of all symptoms following supportive therapy all pointed towards the possible diagnosis of ciprofloxacin-induced hepatotoxicity. The patient was treated with supportive therapy, and subsequently, her symptoms resolved over the next few days with the improvement of her liver enzyme levels. The patient was discharged with instructions to avoid ciprofloxacin and other fluoroquinolones in the future. Clinicians should maintain a high degree of suspicion when treating patients with ciprofloxacin who subsequently develop signs and/or symptoms of liver injury.