PubMed ID:
37739311
Public Release Type:
Journal
Publication Year: 2024
Affiliation: 1Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, Md. Electronic address: bilal.a.asif@gmail.com.
2Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), Bethesda, Md. Electronic address: christopher.koh@nih.gov.
3Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn.
4Duke Clinical Research Institute, Duke University, Durham, NC.
5Department of Medicine, Indiana School of Medicine, Indianapolis, Ind.
6Department of Medicine, University of Michigan School of Medicine, Ann Arbor, Mich.
7Division of Hepatology and Nutrition, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Md.
8Department of Medicine, Einstein Healthcare Network, Philadelphia, Pa.
9Liver Disease Research Branch, Division of Digestive Diseases and Nutrition, NIDDK, NIH, Bethesda, Md.
DOI:
https://doi.org/10.1016/j.jaip.2023.09.011
Authors:
Hoofnagle JH,
Fontana RJ,
Barnhart H,
Gu J,
Li Y-J,
Chalasani N,
Hayashi PH,
Koh C,
Navarro VJ,
Phillips EJ,
Asif BA
Request IDs:
23051
Studies:
DILIN: Prospective
Background: Intravenous vancomycin therapy can cause liver injury as well as ""drug reaction with eosinophilia and systemic symptoms"" (DRESS) syndrome. This study aimed to better define the clinical features and HLA associations of vancomycin-induced liver injury. Objective: To describe clinical, biochemical, and temporal characteristics of vancomycin-induced liver injury. Methods: Cases of liver injury with recent exposure to vancomycin who were enrolled in the US Drug-induced Liver Injury Network between 2004 and 2020 were assessed. Sequencing of HLA alleles was performed on stored blood samples. Results: Among 1697 cases of drug-induced liver injury identified between 2004 and 2021, 9 (0.5%) were attributed to intravenous vancomycin. The 9 cases included 6 men, median age 60 years (range, 23-85 days), and treatment for 26 days (range, 1-34 days). The clinical presentation was DRESS syndrome in 8 patients, of whom 6 received corticosteroids. Liver injury varied from hepatocellular to cholestatic and from mild (n = 5) to fatal (n = 1). In survivors, liver injury and DRESS syndrome ultimately resolved. HLA typing demonstrated the HLA-A∗32:01 allele in 7 vancomycin cases (78%, all with DRESS syndrome), versus 1 of 81 cases (1.2%) exposed but not attributed to vancomycin, and 113 of 1708 cases (6.6%) without vancomycin exposure. The allele frequency in vancomycin cases was 0.44 compared with less than 0.04 in US populations. Conclusions: Vancomycin-induced liver injury is commonly associated with DRESS syndrome and linked to HLA-A∗32:01. HLA-A∗32:01 testing could be considered early to risk-stratify patients using long-term intravenous vancomycin therapy.