Cephalexin Induced Cholestatic Jaundice
The present case has been published in the journal Case Reports in Gastrointestinal Medicine.

A 57-year-old male presented to the emergency department with shortness of breath, leg cramps, and a skin rash 6 days after being started on cephalexin for a neck abscess. The patient also complained of generalized pruritus. His past medical history was significant for diabetes and the medications he was taking for it were metformin and glipizide. A maculopapular rash was noted on his trunk, back, buttocks, and forearms. He also had scleral icterus.

On the day of admission laboratory findings were Aspartate transaminase−268 u/L (8–48), Alanine transaminase (ALT)—267 u/L (7–55), alkaline phosphatase—429 u/L (45–115), total bilirubin—4.5 mg/dL (0.1–1.0), and direct bilirubin—3.5 mg/dL. Markers for synthetic function of the liver including albumin, prothrombin time, and thyroid function tests were all normal.

He was worked up for other possible causes of obstructive jaundice such as primary biliary cirrhosis and sclerosing cholangitis with anti-nuclear, anti-mitochondrial, and anti-smooth muscle antibodies, all of which were also negative. CT of the abdomen revealed a normal sized liver and spleen along with cholelithiasis without any evidence of biliary duct dilatation.

Ultrasound of the abdomen revealed cholelithiasis without any other significant findings. Cephalexin was immediately stopped. The patient was also put on cholestyramine with symptomatic relief of the itching. The patient was also put on prednisone with the dose being tapered.

Over the following 2 days, his liver function tests (LFTs) trended down slightly and the skin eruptions resolved. The patient was discharged home with prescriptions of oral doxycycline for the abscess; cholestyramine and prednisone taper. The patient was followed up as an outpatient after 4 weeks, at which point his LFTs were noted to be completely normal.

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