# Persistent Hepatocellular Secretory Failure Secondary to Flucloxacillin-Induced Liver Injury: A Case With Successful Response to Rifampicin

## TL;DR

An elderly man with severe liver issues after flucloxacillin treatment improved with rifampicin, showing a rare liver condition can be treated.

## Contribution

Demonstrates successful treatment of hepatocellular secretory failure with rifampicin after flucloxacillin-induced injury.

## Key findings

- Rifampicin led to gradual improvement in symptoms and bilirubin levels.
- Liver biopsy showed preserved architecture with hepatocellular cholestasis.
- No other causes of liver injury were identified.

## Abstract

We report the case of an 80-year-old male who developed severe cholestatic jaundice following two courses of flucloxacillin prescribed for a soft-tissue infection. Despite discontinuation of the antibiotic, serum bilirubin remained markedly elevated eight weeks later, accompanied by persistent pruritus. Comprehensive evaluation for acute liver injury, including viral, autoimmune, and metabolic studies as well as abdominal imaging, was unremarkable. A liver biopsy demonstrated preserved hepatic architecture with prominent hepatocellular cholestasis, consistent with hepatocellular secretory failure.

After consulting with a specialist hepatology centre, the patient was initiated on rifampicin monotherapy, resulting in gradual symptomatic improvement and a progressive decline in bilirubin levels over subsequent weeks. This case highlights the importance of maintaining a high index of suspicion for hepatocellular secretory failure in patients with persistent hyperbilirubinemia following withdrawal of a potential hepatotoxic agent. Targeted therapy with rifampicin can result in both symptomatic and biochemical improvement in hepatic function.