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Possible severe piperacillin-tazobactam–associated drug-induced liver injury after re-exposure: a case report

Year: 2026

Type: article

Abstract: Background: Drug-induced liver injury (DILI) is an important cause of acute liver failure, and antimicrobial agents are among its most frequent causes. However, the association of clinically apparent liver injury with piperacillin-tazobactam is uncommon. Case presentation: A 73-year-old man with normal liver biochemistry at admission received empirical piperacillin-tazobactam for suspected pulmonary and central nervous system infection. Liver biochemical abnormalities were first detected after 4 days of treatment. The patient's aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels markedly decreased after the withdrawal of suspected hepatotoxic drugs and supportive treatment, whereas alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), and total bilirubin levels continued to increase over the same period. Piperacillin-tazobactam was subsequently restarted because of recurrent fever and concern about inadequately controlled bacterial infection. However, liver injury worsened sharply by then, with jaundice, elevations in marked aminotransferase and alkaline phosphatase levels, and an increase in international normalized ratio (INR). After evaluation of alternative causes, DILI was considered the most likely diagnosis. Piperacillin-tazobactam was discontinued again, and supportive treatment, including double plasma molecular adsorption system therapy, was provided; AST and ALT levels and INR improved substantially thereafter, whereas ALP, GGT, and total bilirubin levels remained abnormal, indicating that cholestasis had not yet resolved at discharge. Conclusion: The temporal association, improvement after drug withdrawal, and pronounced deterioration after re-exposure support a diagnosis of possible piperacillin-tazobactam-associated DILI. Clear documentation and communication of suspected adverse drug reactions during transfers of care are essential to prevent inadvertent re-exposure.

Source: Frontiers in Medicine

DOI: 10.3389/fmed.2026.1977830

Authors: Jingwen Ren, Weifeng Yu, Yanli Dai

Institution: Chengdu University of Traditional Chinese Medicine

Language: English

Topic: Drug-Induced Hepatotoxicity and Protection

Subfield: Pharmacology

Field: Pharmacology, Toxicology and Pharmaceutics

Domain: Life Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,801