Abstract: PUB048
A Case of Terbinafine-Associated Rhabdomyolysis and Drug-Induced Liver Injury (DILI) That Progressed to Acute Renal and Liver Failure
Session Information
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Author
- Mosquera Cordero, Gabriela Solange, Novant Health New Hanover Regional Medical Center, Wilmington, North Carolina, United States
Introduction
Terbinafine is commonly prescribed for the treatment of onychomycosis. Has been associated with acute hepatic injury and rarely associated with rhabdomyolysis, acute renal failure (ARF) and liver failure (LF). Here we present a case of a patient presenting with general muscle weakness with elevated CK, abnormal renal and hepatic function. Notably, the only new medication reported was terbinafine 3 weeks prior to hospital admission.
Case Description
A 72 year-old female presented to the hospital for worsening of general muscle weakness. Patient completed treatment for onychomycosis with terbinafine 3 weeks prior. The patient denied any other new medications for the past few years. Lower extremity weakness was initially attributed to worsening of spinal stenosis. Lumbosacral MRI was performed, and it showed progression of spinal stenosis but no cord compression. Neurosurgery consult advised against surgical intervention. Chemistry was relevant for CK >9000; Cr 5.78; BUN 117; with a mixed hepatocellular and cholestatic pattern. Autoimmune and infectious etiology were investigated but all were negative. USG and MRI showed CBD dilation correlated with age and post cholecystectomy status. Patient’s CK continued upward with minimal urine output. Patient rapidly decompensated, requiring transfer to ICU, and dialysis. Unfortunately, the patient passed away hours later.
Discussion
Terbinafine is a common antifungal drug used for onychomycosis that may cause hepatic or renal toxicity. The side effects are usually self-limiting, but can rarely progress to rhabdomyolysis, ARF, DILI and LF. Few cases of rhabdomyolysis and ARF associated with Terbinafine have been reported, and even less cases were associated with DILI leading to LF. There are limitations with the definitive diagnosis due the patient passed away before perfforming liver or renal biopsy. Treatment primarily consists of stopping the causative agent and NAC for DILI, but some cases with liver failure will require liver transplantation, and dialysis for worsening of renal failure.
There is a lack of guidelines and cases associating Terbinafine with rhabdomyolysis, ARF, or LF. Nevertheless, physicians need to be aware and carefully monitor patients when prescribing this medication, especially with prior history of chronic renal or liver conditions or any chemistry abnormalities related to its use.