Autoimmune hepatitis after high-dose intravenous methylprednisolone pulse in RR-MS

Abstract

<jats:title>Abstract</jats:title><jats:p>Three weeks after the administration of intravenous methylprednisolone therapy, a 42-year-old female patient suffering from relapsing-remitting multiple sclerosis (RR-MS) presented with a profound elevation of liver transaminases (GOT 485 U/l, GPT 1082 U/l, glutamyl transpeptidase 170 U/l). Liver biopsy revealed a profound, still active hepatitis with portal lymphocytic infiltration and fibrosis. Most likely, existing acute hepatitis was of autoimmune origin and emerged from an immune rebound phenomenon after immunosuppressive therapy.</jats:p>

Bolus de méthylprednisolone révélant une hépatite auto-immune chez une patiente atteinte de sclérose en plaques

“…L'association à plusieurs maladies autoimmunes a été décrite, dominée par la polyarthrite rhumatoïde et la dysthyroïdie auto-immune [1]. L'association de la maladie à l'HAI est rare, rapportée uniquement sous forme de faits cliniques [2][3][4]. La prévalence de l'HAI semble, cependant, être dix fois supérieure chez les malades ayant une SEP par rapport à la population générale [5].…”

Development of autoimmune hepatitis type 1 after pulsed methylprednisolone therapy for multiple sclerosis: A case report

“…Duchini et al [3] have reported a case of AIH occur ring during treatment with IFN-β. Conversely, Reuβ et al [5] have reported a case of AIH that developed after high-dose intravenous methylprednisolone pulse in MS and speculated that AIH may occur in patients with multiple autoimmunity as an immune rebound phenomenon after immunosuppressive regimens.…”

“…In fact, some reports have described AIH occurring in patients with multiple autoimmunity after pulsed methylprednisolone therapy [5,[17][18] . In particular, withdrawal of glucocorticoids after pulsed methylprednisolone therapy might have induced immune rebound phenomenon in the present case.…”

“…Biopsy specimen of the liver showed bridging perivenular necrosis with infiltration of inflammatory cells including eosinophils (Figure 1). A lymphocyte-stimulation test for IFN-β yielded negative results, but the patient displayed a score of 9 according to the criteria for drug-induced liver injuries [5] , indicating a high probability of drug-induced liver injury. All these findings led to the diagnosis of drug-induced liver injury caused by IFN-β.…”

“…IFN-β is associated with hepatotoxicity, although it rarely induces severe liver injury. It was reported that autoimmune hepatitis (AIH) occurs during IFN-β therapy for MS [3,4] , but only one report has described the occurrence of AIH after intravenous methylprednisolone pulse therapy for MS [5] . We describe herein a case of a MS patient who developed AIH after treatment with IFN-β and pulsed methylprednisolone.…”