Plasmapheresis for hyperbilirubinemia and bile cast nephropathy after terbinafine therapy
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We report a 62-year-old Caucasian female who was treated with plasmapheresis for hyperbilirubinemia that was triggered by cholestatic liver injury that likely developed from terbinafine therapy. She initially presented with fatigue, pruritus, and jaundice. Her peak serum total bilirubin level was 66.5 mg/dL. She also had an acute kidney injury with an initial urinalysis that showed 30 proteins, 4+ bilirubin, 0-2 red blood cells, 0-5 white blood cells, 0-2 hyaline casts, and 3-5 granular casts with suspicion for bile cast nephropathy. During her hospitalization, hemodialysis and plasmapheresis were performed, and her total bilirubin decreased to 3.1 mg/dL at the time of transfer to another facility about two months after her initial presentation.
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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 License.