Fatal Liver Failure After High-Dose Glucocorticoid Pulse Therapy in a Patient with Severe Thyroid Eye Disease

Weissel, M; Hauff, W.

doi:10.1089/thy.2000.10.521

Cited by 100 publications

(73 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Until recently, regimens with high-dose intravenous (iv) methylprednisolone (mPSL) have been commonly used. However, severe and acute liver damage, including 4 fatalities, have been associated with highdose iv GC therapy (cumulative GC dose of 8.3 g to 15.0 g) [3,4]. Le Moli et al proposed that cumulative doses up to 8.0 g are safe [5] and the European Group on Graves' Orbitopathy (EUGOGO) recommends a cumulative mPSL dose of <8.0 g during a course of iv GC therapy [6].…”

Section: Clinical and Ophthalmic Measurementsmentioning

confidence: 99%

Overall safety and efficacy of high-dose and low-dose intravenous glucocorticoid therapy in patients with moderate-to-severe active Graves’ ophthalmopathy

et al. 2016

View full text Add to dashboard Cite

Abstract. The objective of this study was to compare the safety and efficacy of high-dose and low-dose intravenous (iv) glucocorticoid (GC) therapy in patients with Graves' ophthalmopathy (GO) and to investigate which factors may help determine appropriate iv GC doses. The medical records of 43 patients who received different doses of iv GCs for GO were retrospectively reviewed. Twenty patients received high-dose iv GCs (HD group, cumulative dose 9.0-12.0 g) and 18 received low-dose iv GCs (LD group, cumulative dose 4.5 g). Five patients with previous treatment for GO were excluded. Changes in ophthalmic parameters after treatment and frequencies of adverse effects due to GCs of the 2 groups were compared. We also reviewed the incidence of GO progression and hepatic dysfunction after patients were discharged. We evaluated correlations among pretreatment (before treatment) ophthalmic parameters and investigated useful predictive factors for determining iv GC doses. There were no significant differences in ophthalmic parameters reflecting treatment efficacy or overall safety between the groups. Among baseline ophthalmic parameters, corrected signal intensity ratio (cSIR) correlated well with magnetic resonance imaging findings and were more strongly associated with changes in ophthalmic parameters after treatment in the HD group than in the LD group, indicating that pretreatment cSIR might be useful for determining iv GC doses. In conclusion, there were no significant differences in overall safety and efficacy between high-dose and low-dose iv GC therapy in patients with active GO. Further randomized clinical trials with longer observation periods are required to establish the optimal treatment regimen of GO.Key words: Graves' ophthalmopathy, Thyroid-associated ophthalmopathy, Intravenous glucocorticoid therapy, MRI, STIR Since GO is generally considered an autoimmune disorder, glucocorticoid (GC) therapy has been used for GO for the last few decades. Different routes of administration and dosages have been used, and various studies have attempted to identify the optimal regimen Original ©The Japan Endocrine Society Submitted Jan. 20, 2016; Accepted May 10, 2016 as EJ16-0038 Released online in J-STAGE as advance publication Jun. 5, 2016 Correspondence to: Naotetsu Kanamoto, M.D., Ph.D., Department of Endocrinology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan. E-mail: kyotetsu@kuhp.kyoto-u.ac.jp * Current affiliation Abbreviations: GO, Graves' ophthalmopathy; GD, Graves' disease; GC, glucocorticoid; iv, intravenous; mPSL, methylprednisolone; EUGOGO, European Group on Graves' Orbitopathy; MRI, magnetic resonance imaging; CAS, Clinical Activity Score; SIR, signal intensity ratio; PSL, prednisolone; CAS, clinical activity score; STIR, short tau inversion recovery; T1W, T1-weighted; ROIs, regions-of-interest; cSIR, corrected SIR; ANCOVA, analysis of covariance. decreasing visual acuity; and one or more enlarged extraocular muscles with high intensity signals on T2-we...

show abstract

Section: Clinical and Ophthalmic Measurementsmentioning

confidence: 99%

Overall safety and efficacy of high-dose and low-dose intravenous glucocorticoid therapy in patients with moderate-to-severe active Graves’ ophthalmopathy

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Such that serious of hepatic injury that related to methylprednisolone occur rarely and unpredictable to cause hepatotoxicity, so the confirmation of drug-induced liver injury needs exclusion of other viral and immunological diseases. For the risk of sever liver injury that is caused by methylprednisolone may prevent its progression the time of recognition of this complication and withdrawal of the drug [7] [8], we report a serious idiosyncratic liver injury in a patient with multiple sclerosis that were related to high dose of methylprednisolone treatment. An unintentional re-challenge test in 2015 was confirmed the relationship of methylprednisolone and the onset hepatotoxicity.…”

Section: Discussionmentioning

confidence: 99%

Hepatotoxicity Induced by High Dose of Methylprednisolone Therapy in a Patient with Multiple Sclerosis: A Case Report and Brief Review of Literature

Kadle¹,

Mazurchik²

2016

OJGas

View full text Add to dashboard Cite

Toxic hepatitis due to drugs is an important and frequent drug adverse reaction in clinical practice. Here, we report a case of high dose methylprednisolone-induced acute hepatitis in a 51-yearold woman that suffers from multiple sclerosis while steroids are usually safe drugs with regards to liver injury and even they are the treatment choice of autoimmune hepatitis, but the literatures about corticosteroids showed are not entirely safe to liver injury and they have occasionally linked to hepatotoxicity. Although recent reports have demonstrated that prednisolone may cause hepatitis. This case report includes a brief review of the relevant literature on corticosteroids-induced hepatitis that is presented.

show abstract

“…El tercero de los casos, el de un varón de 76 años que sufrió la aparición de un fallo hepático fulminante no dispone de confirmación histológica (19).…”

Section: Discussionunclassified

Toxicidad hepática recurrente secundaria a metilprednisolona intravenosa

Fernández

Riesco

Moreira

et al. 2008

Rev. esp. enferm. dig.

View full text Add to dashboard Cite

INTRODUCCIÓNLa hepatotoxicidad inducida por fármacos es una de las etiologías más comunes de hepatitis aguda en nuestro medio y representa la causa más frecuente de fallo hepático fulminante en EE. UU. (1). Sin embargo, las tasas reales de hepatitis secundaria a fármacos son desconocidas (2). La expresión clínica de estos cuadros es muy variable, oscilando entre alteraciones asintomáticas de las enzimas hepáticas hasta fallo hepático agudo fulminante y su diagnóstico precisa de un alto índice de sospecha y se sustenta en una correcta anamnesis y la exclusión de las causas más comunes potencialmente responsables (3,4 RESUMENLas reacciones adversas hepáticas relacionadas con la administración de fármacos (hepatotoxicidad) son cuadros relativamente frecuentes que presentan una amplia variabilidad clínica e histoló-gica. La identificación precoz de estos cuadros es fundamental en la práctica clínica debido a su potencial gravedad. En la mayoría de los casos la suspensión del fármaco desencadenante es suficiente para la resolución del cuadro clínico.A pesar de que los esteroides son utilizados en una amplia variedad de situaciones clínicas, la notificación de cuadros de hepatotoxicidad secundaria a esteroides intravenosos es excepcional.Presentamos el caso clínico de una mujer diagnosticada de esclerosis múltiple, que recibió metilprednisolona a altas dosis en forma de "pulsos" intravenosos como tratamiento de las reagudizaciones de su enfermedad y presentó 3 brotes recurrentes de hepatitis de predominio hepatocelular con un patrón clínico, analíti-co e histológico compatible con toxicidad hepática aguda secundaria a metilprednisolona intravenosa. En el tercer episodio se realizó una biopsia hepática que demostró un patrón de hepatitis aguda con necrosis líticas confluentes, histología no descrita previamente en pacientes tratados con esteroides intravenosos.Palabras clave: Metilprednisolona. Hepatotoxicidad. Esclerosis múltiple. ABSTRACTAdverse drug reactions (hepatotoxicity) are a frequent cause of acute liver injury with a wide clinical and histological spectrum. An early recognition of drug-related liver disease has been considered essential in clinical practice due to potential risks. In most cases exposure discontinuation improves the clinical picture.Steroids are used in a variety of clinical settings. However, intravenous steroids have rarely been associated with hepatotoxicity. We report the case of a middle-aged woman with multiple sclerosis who received a bolus of methylprednisolone on three occasions for the management of relapsing disease, with the development of repeated episodes of elevated liver enzymes after corticoid administration. In the third episode a liver biopsy was performed, which showed acute hepatitis with bridging necrosis; such histological picture has not been described before in patients treated with intravenous steroids.

show abstract

Fatal Liver Failure After High-Dose Glucocorticoid Pulse Therapy in a Patient with Severe Thyroid Eye Disease

Cited by 100 publications

References 6 publications

Overall safety and efficacy of high-dose and low-dose intravenous glucocorticoid therapy in patients with moderate-to-severe active Graves’ ophthalmopathy

Overall safety and efficacy of high-dose and low-dose intravenous glucocorticoid therapy in patients with moderate-to-severe active Graves’ ophthalmopathy

Hepatotoxicity Induced by High Dose of Methylprednisolone Therapy in a Patient with Multiple Sclerosis: A Case Report and Brief Review of Literature

Toxicidad hepática recurrente secundaria a metilprednisolona intravenosa

Contact Info

Product

Resources

About

Fatal Liver Failure After High-Dose Glucocorticoid Pulse Therapy in a Patient with Severe Thyroid Eye Disease

Cited by 100 publications

References 6 publications

Overall safety and efficacy of high-dose and low-dose intravenous glucocorticoid therapy in patients with moderate-to-severe active Graves&rsquo; ophthalmopathy

Overall safety and efficacy of high-dose and low-dose intravenous glucocorticoid therapy in patients with moderate-to-severe active Graves&rsquo; ophthalmopathy

Hepatotoxicity Induced by High Dose of Methylprednisolone Therapy in a Patient with Multiple Sclerosis: A Case Report and Brief Review of Literature

Toxicidad hepática recurrente secundaria a metilprednisolona intravenosa

Contact Info

Product

Resources

About

Overall safety and efficacy of high-dose and low-dose intravenous glucocorticoid therapy in patients with moderate-to-severe active Graves’ ophthalmopathy

Overall safety and efficacy of high-dose and low-dose intravenous glucocorticoid therapy in patients with moderate-to-severe active Graves’ ophthalmopathy