Chronic Hepatitis C, Ibuprofen, and Liver Damage

was admitted to hospital. Physical examination findingswere normal except for jaundice. Serum chemistry showedtotal bilirubin of 28.45 mg/dl (normal 0.3–1.3); conju-gated bilirubin, 20.6 mg/dl (normal 0–0.4); ALP, 249U/L (normal 35–120); AST, 37 U/L (normal 5–40),and ALT, 58 U/L (normal 5–40). Abdominal ultrasonog-raphy, CT scan, and cholangiography magnetic resonancewere normal and ruled out obstruction of the bile ducts.Serology excluded viral causes. Screening for autoantibod-ies and metabolic diseases was negative. A liver biopsyspecimen showed predominantly casts in canaliculi andmild portal inflammatory infiltrates with lymphocytes andeosinophils. Results of liver tests became normal during thesubsequent 2 months.Trovafloxacin, another new quinolone, has been with-drawn from the market in Europe and limited to life-threat-ening conditions in the United States because of hepatictoxicity (3–6). This is, to our knowledge, the first publishedreport of liver injury due to moxifloxacin. Other causes ofliver injury were ruled out. The histological picture wasconsistent with drug-induced hepatic injury. It is noteworthythat there was a delay of 3 wk between the end of thetreatment and the onset of jaundice that may hinder thediagnosis.Santiago Soto, M.D.Leopoldo Lo´pez-Rose´s, M.D.Susana A´vila, M.D.A´ngel Lancho, M.D.Abel Gonza´lez, M.D.Eva Santos, M.D.Begon˜a Urraca, M.D.Digestive Diseases UnitHospital Xeral de LugoLugo, Spain