Levonorgestrel-Releasing Intrauterine Device-Related Acute Liver Injury

Abstract

Oral contraceptives have long been associated with liver injury. However, very little attention is paid to the metabolic side effects of hormone-releasing intrauterine devices (IUDs). These devices are generally considered safe and commonly used. We report for the first time acute liver injury associated with a levonorgestrel-releasing IUD. Our patient did not have any comorbidities that could have caused or exacerbated liver injury. A detailed workup and liver biopsy remained negative for any other potential cause of liver injury. The patient’s symptoms resolved with removal of the device. She remained symptom free on subsequent outpatient follow-ups.

Drug-induced liver injury secondary to increased levonorgestrel exposure in a patient taking ritonavir

“…17,18 Reports include one case where the DILI returned on re-challenge, a case in a patient taking a boosted protease inhibitor for HIV, and a case of confirmed panacinar hepatitis secondary to the levonorgestrel intrauterine system (IUS). [19][20][21] To our knowledge, there are no reports of DILI secondary to the use of levonorgestrel POEC and none are listed by the MHRA. 17 In conclusion, we present the first case of presumed DILI secondary to a levonorgestrel POEC interaction with ritonavir, resulting in increased exposure to levonorgestrel.…”

“…17,18 Reports include one case where the DILI returned on re-challenge, a case in a patient taking a boosted protease inhibitor for HIV, and a case of confirmed panacinar hepatitis secondary to the levonorgestrel intrauterine system (IUS). 19–21 To our knowledge, there are no reports of DILI secondary to the use of levonorgestrel POEC and none are listed by the MHRA. 17…”