Cholangiopathy after short-term administration of piperacillin and imipenem/cilastatin

We describe a patient who suffered from intestinal perforation after abdomi nal. trauma. Perioperatively, he was treated with a single dose of piperaci llin and 9 doses of imipenem/cilastatin over 3 days. The patient was discha rged 5 days after surgery in good clinical condition and with normal liver values except for a marginal elevation of alanine aminotransferase. Two wee ks after discharge, he developed fatigue, fever and pruritus, necessitating rehospitalization. He was jaundiced and had elevated alkaline phosphatase and transaminases. After exclusion of an intraabdominal fluid collection, a vascular problem, and infectious or autoimmune liver disease, a liver biop sy was performed. The biopsy revealed centrizonal bilirubinostasis, a porta l infiltrate rich in eosinophils and cholangitis. Lymphocyte transformation tests for piperacillin and imipenem/cilastatin were positive, suggesting a n immunological mechanism for the observed hepatopathy. Cholestasis gradual ly decreased but was detectable for several weeks. The patient had a full c linical and biochemical recovery after 3 months. We conclude that short-ter m therapy with piperacillin, imipenem/cilastatin or the combination of thes e drugs can lead to the same type of hepatopathy as described for amoxycill in/clavulanic acid or antistaphylococcal penicillins. Liver biopsy and posi tive lymphocyte transformation are compatible with an immunological mechani sm.