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Abstract：
Hepatic injuries attributable to terbinafine usage are a well-documented yet infrequent phenomenon. This case study details the clinical presentation and management of a 70-year-old Hispanic female, with no previous medical history, subsequently hospitalized for progressive jaundice, right upper quadrant abdominal discomfort, and worsening pruritus. A comprehensive review of her prior records revealed a recent terbinafine prescription for onychomycosis, which she took consistently for five weeks and then self-discontinued four weeks before her current admission. Laboratory tests on admission revealed a cholestatic pattern of liver injury, evident by transaminitis and conjugated hyperbilirubinemia. The R factor used to determine whether a liver injury is hepatocellular or cholestatic was 0.9. Further diagnostic imaging, including abdominal ultrasound, CT of the abdomen, and magnetic resonance cholangiopancreatography, failed to disclose an obstructive pathology, revealing only cholelithiasis and chronic cholecystitis. Therapeutically, the patient was initiated on hydroxyzine to address symptoms of pruritus, and then subsequently underwent a liver biopsy. Histopathologic findings from the biopsy revealed benign hepatic parenchyma demonstrating focal canalicular cholestasis, mild chronic inflammation involving select portal tracts, and chronic lobular inflammation, suggesting terbinafine-induced hepatotoxicity. This case highlights the challenges of diagnosing terbinafine-induced liver injury, emphasizing the need for a high index of clinical suspicion and recognizing the potential for prolonged symptomatic manifestation after drug discontinuation. This article provides valuable insights into the complexities inherent in such diagnoses and significantly enriches a medical provider\'s approach to diagnosing and treating unexplained liver injuries.
摘要：
使用特比萘芬引起的肝损伤是有据可查但很少见的现象。此案例研究详细介绍了一名70岁的西班牙裔女性的临床表现和管理，没有既往病史,随后因进行性黄疸住院，右上腹不适，瘙痒恶化。对她先前记录的全面审查显示，最近特比萘芬治疗甲癣的处方，她持续服用了五周，然后在目前入院前四周自行停药。入院时的实验室检查显示胆汁淤积性肝损伤，可见转氨酶和共轭高胆红素血症。用于确定肝损伤是肝细胞还是胆汁淤积的R因子为0.9。进一步的诊断成像，包括腹部超声,腹部CT,磁共振胰胆管造影术，没有透露阻塞性病理学,只显示胆石症和慢性胆囊炎。治疗学上,患者开始服用羟嗪以解决瘙痒症状，随后接受了肝活检。活检的组织病理学发现，良性肝实质显示局灶性小管淤积，轻度慢性炎症涉及选定的门静脉道，和慢性小叶炎症，提示特比萘芬诱导的肝毒性。这个案例突出了诊断特比萘芬引起的肝损伤的挑战，强调需要高的临床怀疑指数，并认识到药物停药后长期症状表现的可能性。本文提供了对此类诊断中固有的复杂性的宝贵见解，并显着丰富了医疗提供者诊断和治疗无法解释的肝损伤的方法。
