{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T20:27:28Z","timestamp":1790108848562,"version":"4.0.1"},"reference-count":11,"publisher":"FapUNIFESP (SciELO)","issue":"1","license":[{"start":{"date-parts":[[2020,1,1]],"date-time":"2020-01-01T00:00:00Z","timestamp":1577836800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2020,1,1]],"date-time":"2020-01-01T00:00:00Z","timestamp":1577836800000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2020,1,1]],"date-time":"2020-01-01T00:00:00Z","timestamp":1577836800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Assoc. Med. Bras."],"abstract":"<jats:p>SUMMARY Drug-induced liver injury (DILI) to flucloxacillin is rare and is classified as idiosyncratic, as it is dependent on individual susceptibility, unpredictable, and dose-independent. The authors present the case of a 74 - year - old man with a history of monoclonal gammopathy under investigation and alcoholic habits of 24 g\/day, with asthenia, anorexia, nausea, abdominal discomfort, and fever with three days of evolution. He was treated with two courses of antibiotic therapy with flucloxacillin to erysipelas previously (3 months and 2 weeks before admission). Lab tests showed serum AST levels of 349 U\/L, ALT 646 U\/L, alkaline phosphatase 302 U\/L, GGT 652 U\/L, total bilirubin 3.3 mg\/dL and direct bilirubin 2.72 mg\/dL. Infectious, autoimmune, and metabolic causes were ruled out. Magnetic resonance cholangiopancreatography showed normal results. Liver biopsy showed mild multifocal (predominantly microvesicular) steatosis; marked changes in the centrilobular areas (sinusoidal dilatation, marked congestion, hemorrhage, and multifocal hepatocyte collapse); expansion of the portal areas with the formation of bridges; proliferated bile ducts and inflammatory infiltrate of variable density, predominantly mononuclear type. The HLA-B*5701 screening test was positive. Hepatic biochemical tests remain abnormal with a significative increase in total bilirubin, which reached levels of 24.1 mg\/dL, with the development of jaundice, pruritus, and choluria. DILI was assumed, and the patient was treated with ursodeoxycholic acid. There was favorable evolution, without evidence of blood coagulation dysfunction or encephalopathy. The analytic normalization was, however, slow, with evolution to chronicity. The authors present this case to remind the possibility of moderate\/severe drug-induced liver injury to flucloxacillin, an antibiotic commonly used in clinical practice and association with the HLA-B * 5701 allele reported in the literature.<\/jats:p>","DOI":"10.1590\/1806-9282.66.1.12","type":"journal-article","created":{"date-parts":[[2020,2,25]],"date-time":"2020-02-25T15:33:58Z","timestamp":1582644838000},"page":"12-17","source":"Crossref","is-referenced-by-count":21,"title":["Flucloxacillin-Induced Hepatotoxicity - Association with HLA-B*5701"],"prefix":"10.1590","volume":"66","author":[{"given":"M\u00f3nica","family":"Teixeira","sequence":"first","affiliation":[{"name":"Tondela-Viseu Hospital Center,  Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5152-7505","authenticated-orcid":false,"given":"Sara","family":"Macedo","sequence":"additional","affiliation":[{"name":"Tondela-Viseu Hospital Center,  Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0066-2472","authenticated-orcid":false,"given":"T\u00e2nia","family":"Batista","sequence":"additional","affiliation":[{"name":"Tondela-Viseu Hospital Center,  Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7659-7232","authenticated-orcid":false,"given":"Sofia","family":"Martins","sequence":"additional","affiliation":[{"name":"Tondela-Viseu Hospital Center,  Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7472-7665","authenticated-orcid":false,"given":"Andreia","family":"Correia","sequence":"additional","affiliation":[{"name":"Tondela-Viseu Hospital Center,  Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5848-8051","authenticated-orcid":false,"given":"Lu\u00eds Costa","family":"Matos","sequence":"additional","affiliation":[{"name":"Tondela-Viseu Hospital Center,  Portugal; University of Beira Interior,  Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"530","published-online":{"date-parts":[[2020,1]]},"reference":[{"issue":"7","key":"ref1","doi-asserted-by":"crossref","first-page":"2246","DOI":"10.1053\/j.gastro.2010.04.001","article-title":"Risk factors for idiosyncratic drug-induced liver injury","volume":"138","author":"Chalasani N","year":"2010","journal-title":"Gastroenterology"},{"issue":"6","key":"ref2","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.1016\/j.jhep.2019.02.014","article-title":"EASL clinical practice guidelines: drug-induced liver injury","volume":"70","year":"2019","journal-title":"J Hepatol"},{"issue":"4","key":"ref3","first-page":"239","article-title":"Hepatites t\u00f3xicas: revis\u00e3o da literatura","volume":"12","author":"Matos LC","year":"2005","journal-title":"Rev Soc Port Med Inter"},{"issue":"1","key":"ref4","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1111\/j.1365-2125.2005.02370.x","article-title":"Risk of cholestatic liver disease associated with flucloxacillin and flucloxacillin prescribing habits in the UK: cohort study using data from the UK General Practice Research Database","volume":"60","author":"Russmann S","year":"2005","journal-title":"Br J Clin Pharmacol"},{"issue":"7","key":"ref5","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1038\/ng.379","article-title":"HLA-B*5701 genotype is a major determinant of drug-induced liver injury due to flucloxacillin","volume":"41","author":"Daly AK","year":"2009","journal-title":"Nat Genet"},{"issue":"7","key":"ref6","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1038\/ajg.2014.131","article-title":"ACG Clinical Guideline: the diagnosis and management of idiosyncratic drug-Induced liver injury","volume":"109","author":"Chalasani NP","year":"2014","journal-title":"Am J Gastroenterol"},{"issue":"2","key":"ref7","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1002\/hep.26709","article-title":"Hepatic histological findings in suspected drug-induced liver injury: systematic evaluation and clinical associations","volume":"59","author":"DE<\/underline> <underline>Kleiner","year":"2014","journal-title":"Hepatology"},{"issue":"1","key":"ref8","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.cld.2016.08.006","article-title":"Phenotypes and pathology of drug-induced liver disease","volume":"21","author":"Goodman ZD","year":"2017","journal-title":"Clin Liver Dis"},{"key":"ref9","series-title":"Maria and Victorino (M&V) system of causality assessment in drug induced liver injury"},{"key":"ref10","series-title":"Roussel Uclaf Causality Assessment Method (RUCAM) in drug induced liver injury"},{"issue":"1","key":"ref11","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.cld.2016.08.012","article-title":"Management of acute hepatotoxicity including medical agents and liver support systems","volume":"21","author":"Gonzalez HC","year":"2017","journal-title":"Clin Liver Dis"}],"container-title":["Revista da Associa\u00e7\u00e3o M\u00e9dica Brasileira"],"original-title":[],"link":[{"URL":"http:\/\/www.scielo.br\/pdf\/ramb\/v66n1\/1806-9282-ramb-66-1-0012.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,1,23]],"date-time":"2021-01-23T12:25:04Z","timestamp":1611404704000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_arttext&pid=S0104-42302020000100012&tlng=en"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1]]},"references-count":11,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,1]]}},"alternative-id":["S0104-42302020000100012"],"URL":"https:\/\/doi.org\/10.1590\/1806-9282.66.1.12","relation":{},"ISSN":["1806-9282","0104-4230"],"issn-type":[{"value":"1806-9282","type":"electronic"},{"value":"0104-4230","type":"print"}],"subject":[],"published":{"date-parts":[[2020,1]]}}}