Utility of Tissue Biopsy in Amoxicillin-Clavulanate induced Concomitant Hepatic Failure and Renal Failure: A Case Report

Several reports indicate that amoxicillin-clavulanate can cause both liver injury as well as acute kidney injury. However, the majority of the existing literature has described liver-related injury, with fewer reports noting kidney injury. In this report, we describe a case of concomitant drug induced liver injury (DILI) and acute interstitial nephritis (AIN) as a result of amoxicillin-clavulanate exposure. A 62-year-old African American male presented with one week of generalized weakness, painless jaundice, nausea, vomiting, and diarrhea. Prior to admission, the patient had completed a 10-day course of amoxicillin-clavulanate for bacterial sinusitis. Upon admission, laboratory data revealed transaminitis and elevated creatinine levels suggestive of liver injury and renal failure. Through tissue biopsy of both organs, the diagnosis of amoxicillin-clavulanate induced acute liver injury and acute tubulointerstitial nephritis with bile cast nephropathy was made. This case highlights the critical role of tissue biopsy in reaching a unifying diagnosis for this rare adverse effect of amoxicillin-clavulanate.