Azithromycin-Induced Liver Injury in Legionnaires' Disease

Drug-induced liver injury (DILI) is the leading cause of acute liver failure in the United States. Azithromycin is a commonly used antibiotic for community-acquired pneumonia that causes liver injury in rare cases. Typically, cholestatic liver injury has been reported for azithromycin, but there have only been a few case reports addressing the association with direct hepatocellular liver injury. This is a case of a 66-year-old man, with no pre-existing liver disease, who was managed for Legionnaires’ disease who sustained a hepatocellular pattern of liver injury associated with azithromycin. We report this case to highlight the importance of prompt recognition of these rare side effects associated with azithromycin and the discontinuation of the drug to facilitate rapid recovery.