{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T21:11:53Z","timestamp":1791321113109,"version":"4.3.1"},"reference-count":10,"publisher":"Wiley","license":[{"start":{"date-parts":[[2013,1,1]],"date-time":"2013-01-01T00:00:00Z","timestamp":1356998400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/3.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Case Reports in Gastrointestinal Medicine"],"published-print":{"date-parts":[[2013]]},"abstract":"<jats:p>Drug induced liver injury (DILI) can result either from dose-dependent direct hepatotoxicity or from an unpredictable dose-independent idiosyncratic reaction. Incidence of idiosyncratic DILI is estimated to be approximately 10\u201315 per 100,000 patient years. Here we report an extremely rare case of metronidazole induced delayed immune-allergic hepatocellular liver injury masquerading as autoimmune hepatitis. A previously healthy 54-year-old Caucasian male, who was treated with metronidazole for<jats:italic>Clostridium difficile<\/jats:italic>associated diarrhea, presented 3 months later with right upper quadrant abdominal pain. Laboratory tests revealed total bilirubin level of 12.7\u2009mg\/dL, direct bilirubin of 7.2\u2009mg\/dL, alanine aminotransferase (ALT) of 973\u2009IU\/L, aspartate transaminase (AST) of 867\u2009IU\/L, alkaline phosphatase (AP) of 96\u2009IU\/L, and an INR of 1.9, suggestive of hepatocellular pattern of injury. A detailed workup for hepatitis revealed no other etiology. A clinical diagnosis of metronidazole induced liver injury was made. With a persistent rise in his bilirubin and transaminase levels, the patient was started on oral prednisone. At the 2-week posthospitalization follow-up visit, the patient reported a significant improvement in his overall sense of being well and liver functions tests trended down substantially (total bilirubin 7.2\u2009mg\/dL, ALT 420\u2009IU\/L, AST 276\u2009IU\/L, AP 183\u2009IU\/L, and INR 1.5).<\/jats:p>","DOI":"10.1155\/2013\/568193","type":"journal-article","created":{"date-parts":[[2013,12,23]],"date-time":"2013-12-23T16:01:08Z","timestamp":1387814468000},"page":"1-4","source":"Crossref","is-referenced-by-count":14,"title":["Metronidazole Induced Liver Injury: A Rare Immune Mediated Drug Reaction"],"prefix":"10.1155","volume":"2013","author":[{"given":"Dayakar","family":"Kancherla","sequence":"first","affiliation":[{"name":"Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0932-4848","authenticated-orcid":true,"given":"Mahesh","family":"Gajendran","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priyanka","family":"Vallabhaneni","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, St. Luke\u2019s University Hospitals and Health Network, Bethlehem, PA 18015, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4827-8362","authenticated-orcid":true,"given":"Kishore","family":"Vipperla","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","reference":[{"key":"1","doi-asserted-by":"publisher","DOI":"10.1517\/17425255.2012.658041"},{"key":"2","doi-asserted-by":"publisher","DOI":"10.1038\/nrgastro.2011.22"},{"key":"3","doi-asserted-by":"publisher","DOI":"10.1055\/s-0029-1240002"},{"issue":"12","key":"4","doi-asserted-by":"crossref","first-page":"947","DOI":"10.7326\/0003-4819-137-12-200212170-00007","volume":"137","year":"2002","journal-title":"Annals of Internal Medicine"},{"key":"5","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2008.09.011"},{"key":"6","doi-asserted-by":"publisher","DOI":"10.1002\/hep.22895"},{"issue":"43","key":"7","first-page":"252","volume":"49","year":"2002","journal-title":"Hepato-Gastroenterology"},{"key":"8","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2009.06.006"},{"key":"9","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1G345"},{"key":"10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2008.10.021"}],"container-title":["Case Reports in Gastrointestinal Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/downloads.hindawi.com\/journals\/crigm\/2013\/568193.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/downloads.hindawi.com\/journals\/crigm\/2013\/568193.xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/downloads.hindawi.com\/journals\/crigm\/2013\/568193.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2017,6,22]],"date-time":"2017-06-22T00:50:55Z","timestamp":1498092655000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.hindawi.com\/journals\/crigm\/2013\/568193\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013]]},"references-count":10,"alternative-id":["568193","568193"],"URL":"https:\/\/doi.org\/10.1155\/2013\/568193","relation":{},"ISSN":["2090-6528","2090-6536"],"issn-type":[{"value":"2090-6528","type":"print"},{"value":"2090-6536","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013]]}}}