Summary
A 72-year old man developed jaundice while on fusidic acid therapy for suspected osteomyelitis. Hyperbilirubinemia was predominantly of the conjugated variety and elevation in liver enzymes was mild and transient. Although serum bilirubin fell rapidly after fusidic acid was stopped, complete resolution of the hyperbilirubinemia took nearly a month. Other possible causes of jaundice were excluded. Light microscopy of a needle liver biopsy showed focal hepatocyte feathery degeneration, intracellular bile retention, and canalicular bile plugging, most prominent in perivenous regions. Electron microscopy revealed varying degrees of canalicular dilatation, loss of microvilli, and disruption of the canalicular membrane with vesicular bleb formation as well as canalicular bile plugs. Widening of the pericanalicular ectoplasmic zone with accumulation of cytoskeletal filaments was also noted. These findings are similar to those reported in experimental cholestasis induced by bile acids. Possible mechanisms of jaundice caused by fusidic acid are discussed.
Similar content being viewed by others
References
Godtfredsen WO, Vangedal S: On the metabolism of fusidic acid in man. Acta Chem Scand 20:1599–1607, 1966
Taylor G, Bloor K: Antistaphylococcal activity of fucidin. Lancet 1:935–937, 1962
Crosbie RB: Treatment of staphylococcal infections with “Fucidin”. Br Med J 1:788–794, 1963
Dineen P: Fusidate sodium in treatment of surgical infections. Am J Surg 96:219–221, 1968
Schumer W, Abtahi H: Sodium fusidate in surgical wound infections. Am J Surg 115:527–530, 1968
Bergdahl S, Elinder G, Eriksson M: Treatment of neonatal osteomyelitis with cloxacillin in combination with fusidic acid. Scand Infect Dis 13:281–282, 1981
Menday AP, Marsh BT: Intravenous fusidic acid (Fucidin) in the management of severe staphylococcal infections: A review of 46 cases. Curr Med Res Opin 4:132–138, 1976
Copperman IJ: The prolonged use of intravenous fusidic acid in severe staphylococcal infections. Br J Clin Pract 26:83–84, 1972
Craig JA: Jaundice in acute pustular psoriasis. Br Med J iii:43, 1974
Humble MW, Eykyn SJ, Phillips I: Staphylococcal bacteremia acid and jaundice. Br Med J 280:1495–1498, 1980
McAreavey D, Redding PJ: Staphylococcal septicemia complicated by probable cloxacillin neurotoxicity and by jaundice induced by fusidic acid. Scot Med J 28:179–180, 1983
Schmid J, Ballonitz L: Fusidic acid in Gunn rats. No influence on serum bilirubin concentration. Arch Dis Child 54:566–567, 1979
Parsons RL, Beavis JP, Paddock GM, David JA, Trounce JR: Additives to intravenous fluids. Br Med J iv:1256, 1976
Carey MC, Small DM: Micellar properties of sodium fusidate, a steroid antibiotic structurally resembling the bile salts. J Lipid Res 12:604–613, 1971
Montet JC, Montet AM, Gerolami A, Amic J, Hauton JC: Glycodihydrofusidate: Biliary excretion and its effect on biliary secretion of the rat. Lipids 11:408–411, 1976
Delage Y, Dumont M, Erlinger S: Effect of glycodihydrofusidate on sulfobromophthalein transport maximum in the hamster. Am J Physiol 231:1875–1878, 1976
Beaudoin M, Carey MC, Small DM: Effects of taurodihydrofusidate, a bile salt analogue on bile formation and biliary lipid secretion in the rhesus monkey. J Clin Invest 56:1431–1441, 1975
Montet JC, Gerolami A, Durbec JP, Crotte C, Montet AM, Hauton JC: Hepatic uptake and biliary excretion of a bile salt analog: Glycodihydrofusidate. Biomedicine 26:60–64, 1977
Narducci F, Pelli MA, Vedovelli A, Morelli A, Fedelli E, Fiorucci MG, Palumbo R: Elevation of serum bile acids induced by sodium fusidate administration in man. Dig Dis Sci 27:283–284, 1982
Schaffner F, Popper H: Morphologic studies of cholestasis. Gastroenterology 37:565–573, 1959
Biava C: Studies on cholestasis—the fine structure and morphogenesis of hepatocellular and canalicular bile pigment. Lab Invest 13:1099–1123, 1964
Layda TJ, Schwarz J, Boyer JL: Scanning electron microscopy of the rat liver. Studies of the effect of taurolithocholate and other models of cholestasis. Gastroenterology 69:724–738, 1975
Miyai K, Richardson AL, Mayr W, Javitt NB: Subcellular pathology of rat liver in cholestasis and choleresis induced by bile salts. Lab Invest 36:249–258, 1977
Phillips MJ, Oda M, Mak E, Fisher MM, Jeejeebhoy KN: Microfilament dysfunction as a possible cause of intrahepatic cholestasis. Gastroenterology 69:48–58, 1975
Gabbiani G, Montesano R, Tuchweber B, Salas M, Orci L: Phalloidin-induced hyperplasia of actin filaments in rat hepatocytes. Lab Invest 33:562–569, 1975
Phillips MJ, Oda M, Funatsy K: Evidence for microfilament involvement in norethandrolone-induced intrahepatic cholestasis. Am J Pathol 93:729–740, 1978
De Vos R, De Wolf-Peeters C, Desmet V, Eggermont E, Van Acker K: Progressive intrahepatic cholestasis (Byler's disease): A case report. Gut 16:943–950, 1975
Fahrlander H, Huber F, Gloor F: Intrahepatic retention of bile in severe bacterial infections. Gastroenterology 47:590–599, 1964
Zimmerman HJ, Fang F, Utili R, Seeff LB, Hoofnagle J: Jaundice due to bacterial infection. Gastroenterology 77:362–374, 1979
Weiss J, Gautam A, Lauff JJ, Sundberg MW, Jatlow P, Boyer JL, Seligson D: The clinical importance of a proteinbound fraction of serum bilirubin in patients with hyperbilirubinemia. N Engl J Med 309:147–150, 1983
Wynn V: Metabolic effects of the steroid antibiotic fusidic acid. Br Med J i:1400–1404, 1965
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Kutty, K.P., Nath, I.V.S., Kothandaraman, K.R. et al. Fusidic acid-induced hyperbilirubinemia. Digest Dis Sci 32, 933–938 (1987). https://doi.org/10.1007/BF01296717
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01296717