TY -的A2 Kapoor Sorabh盟——如是说,艾哈迈德。非盟,哈基姆Seifeldin盟——Shams Christienne AU -贝蒂,Damanpreet盟,阿明Mitual盟——Cappell米切尔s . PY - 2020 DA - 2020/02/18 TI - Clarithromycin-Associated急性肝衰竭导致死亡,大量上消化道出血来自深刻的凝血障碍:病例报告和系统文献综述SP - 2135239 VL - 2020 AB -红霉素导致了大量的急性肝衰竭(ALF)病例，而克拉霉素，一种类似的大环内酯类抗生素，仅报道了6例ALF病例。本文报道一例新的克拉霉素相关性ALF患者，肝脏组织病理学和广泛的检查排除了其他病因，而系统的检查可以更好地描述克拉霉素相关性ALF综合征。一名60岁的非酒精性男性，肝功能基线测试正常，因疑似上呼吸道感染而接受7天疗程的克拉霉素500毫克，每日两次，6天后因弥漫性腹痛入院，AST = 499 U/L和ALT = 539 U/L。AST和ALT在入院第2天升高至约1000 U/L，第3天升高至≥6000 U/L，发展为严重肝性脑病和严重凝血障碍。原计划的肝活检因凝血障碍而取消。对肝脏疾病的感染、免疫和代谢原因的广泛评估均为阴性。腹部计算机体层摄影及多普勒超声检查结果均无显著性差异。患者出现大量急性上消化道出血并伴有凝血。在大量输血后计划进行食管胃十二指肠镜检查，但病人很快因失血性休克而死亡。 Autopsy revealed a golden-brown heavy liver with massive hepatic necrosis and sinusoidal congestion. Rise of AST/ALT to about 1,000 U/L each was temporally incompatible with shock liver because this rise preceded the hemorrhagic shock, but the subsequent AST/ALT rise to ≥6,000 U/L each may have had a component of shock liver. The six previously reported cases were limited by failure to exclude hepatitis E (4), lack of liver biopsy (2), and uninterpretable liver biopsy (1) and by confounding potential etiologies including disulfiram, israpidine, or recent acetaminophen use (3), clarithromycin overdose (1), active alcohol use (1), and severe heart failure (1). Review of 6 previously reported and current case of clarithromycin-associated ALF revealed that patients had AST and ALT values in the thousands. Five patients died and 2 survived. SN - 2090-6587 UR - https://doi.org/10.1155/2020/2135239 DO - 10.1155/2020/2135239 JF - Case Reports in Hepatology PB - Hindawi KW - ER -