A241 AMOXICILLIN-CLAVULANATE INDUCED LIVER INJURY WITH CONCOMITANT AMPULLARY STENOSIS: A CASE REPORT AND LITERATURE REVIEW
Bibliographic record
Abstract
Abstract Background Amoxicillin-clavulanate drug-induced liver injury (DILI) has been reported at a rate of 1 in 2,400 prescriptions1. Patients tend to present with a cholestatic pattern of liver enzyme elevation while hepatocellular enzyme elevation is more commonly reported in younger patients. In mild cases, once amoxicillin-clavulanate is discontinued the patient’s recovery tends to be rapid. Aims We present a patient case and a literature review regarding concomitant ampullary stenosis and amoxicillin-clavulanate induced liver injury. Methods We present a case report outlining a patient’s course and management in hospital. We then conducted a literature review on Pub-Med using the following terms: “ampulla stenosis” and “drug-induced liver injury”. Results A 56-year-old female with a remote history of a cholecystectomy was prescribed amoxicillin-clavulanate for suspected diverticulitis. She completed a 5-day course and then represented with worsening abdominal pain. She was found to have significant transaminitis with a mixed cholestatic-hepatocellular pattern (ALT 726, AST 351, ALP 289). She underwent an MRCP which showed extensive extrahepatic and intrahepatic biliary duct dilations which was disproportionate to expected post-cholecystectomy changes and suggestive of ampullary stenosis. Amoxicillin-clavulanate was discontinued on admission and her liver enzymes normalized as an out-patient three weeks after admission (ALT 34, ALP 125). She was referred for outpatient endoscopic ultrasound for assessment and treatment of her ampullary stenosis. The literature review on PubMed yielded a single case report (n = 1) of a patient with atorvastatin induced liver injury and underlying ampullary stenosis2. In that case, the patient improved when the medication was discontinued and then underwent a sphincterotomy. Conclusions Although seldomly reported in the medical literature there is one other case report of concomitant drug-induced liver injury in a patient with ampullary stenosis. To our knowledge, this is the first case report of amoxicillin-clavulanate induced liver injury in a patient with ampullary stenosis. Potential mechanisms may include ampullary stenosis related biliary stasis which may exacerbate the toxic effects of medications on the liver. Patient’s Biochemical Investigations in Hospital Note: AST was not measured on July 30th. INR was not recorded during the patient’s hospitalization Funding Agencies NoneN/A
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".