Garcia R, English K. Mixed hepatocellular-cholestatic liver injury from cefepime: A case report. World J Clin Cases 2026; 14(4): 117573 [DOI: 10.12998/wjcc.v14.i4.117573]
Corresponding Author of This Article
Kevan English, MD, Department of Internal Medicine, University of Nebraska Medical Center, 42nd and Emile Street, Omaha, NE 68198, United States. keenglish@unmc.edu
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Gastroenterology & Hepatology
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Case Report
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Feb 6, 2026 (publication date) through Feb 11, 2026
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World Journal of Clinical Cases
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2307-8960
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Garcia R, English K. Mixed hepatocellular-cholestatic liver injury from cefepime: A case report. World J Clin Cases 2026; 14(4): 117573 [DOI: 10.12998/wjcc.v14.i4.117573]
World J Clin Cases. Feb 6, 2026; 14(4): 117573 Published online Feb 6, 2026. doi: 10.12998/wjcc.v14.i4.117573
Mixed hepatocellular-cholestatic liver injury from cefepime: A case report
Reicelle Garcia, Kevan English
Reicelle Garcia, Department of Internal Medicine, Creighton University Medical Center - Bergan Mercy, Omaha, NE 68124, United States
Kevan English, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, United States
Co-first authors: Reicelle Garcia and Kevan English.
Author contributions: Garcia R and English K wrote the original draft, contributed to conceptualization, writing, reviewing, and editing; the authors read and approved the final version of the manuscript.
Informed consent statement: Written informed consent was obtained from the patient regarding the publication of this article and the associated image.
Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kevan English, MD, Department of Internal Medicine, University of Nebraska Medical Center, 42nd and Emile Street, Omaha, NE 68198, United States. keenglish@unmc.edu
Received: December 11, 2025 Revised: December 29, 2025 Accepted: January 23, 2026 Published online: February 6, 2026 Processing time: 57 Days and 2.7 Hours
Abstract
BACKGROUND
Cefepime is a fourth-generation cephalosporin antibiotic widely used to treat a variety of serious bacterial infections, including febrile neutropenia, pneumonia, complicated intra-abdominal infections, urinary tract infections, and skin infections. It possesses broad-spectrum action against both gram-positive and gram-negative bacteria, with favorable pharmacokinetics and clinical efficacy, making it a cornerstone in the management of infections, especially in the hospital setting, where resistant organisms are prevalent. Well-known adverse effects include local reactions, gastrointestinal symptoms, and neurologic complications. However, instances of liver injury are rare.
CASE SUMMARY
We report the case of a 73-year-old male who presented to the emergency department (ED) with a 1-week history of productive cough, shortness of breath, and fatigue. Laboratory findings in the ED included leukocytosis, hyponatremia, and elevated procalcitonin. Computed tomography chest without contrast showed a new right-sided pleural effusion and worsening consolidative opacities in both lungs. He was admitted and started vancomycin and cefepime for infected bronchiectasis. Liver function tests subsequently worsened and improved with the discontinuation of cefepime. The patient ultimately died from acute hypoxic respiratory failure two weeks after hospitalization.
CONCLUSION
This case report highlights a rare adverse effect of a commonly used antimicrobial in the hospital setting for various bacterial infections. Prompt cessation of the medication is the primary treatment in cefepime-induced liver injury, and most cases resolve without complications.
Core Tip: Cefepime is a fourth-generation cephalosporin commonly used to treat various bacterial infections. It is safe and generally well-tolerated. While frequently associated with adverse effects such as neurotoxicity and nephrotoxicity, cases of hepatotoxicity are rare. Prompt cessation of the medication is the primary approach in management.
