Mesalamine: Good for IBD but Bad for the Liver? A Case of DILI Caused by Mesalamine

Shah, Nihar; Desai, Aakash; Potashinsky, Alexander; Swales, Colin

doi:10.14309/00000434-201810001-02232

Cited by 2 publications

(3 citation statements)

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“…5-ASA is generally considered a safe drug with few side effects. The estimated annual incidence rate of DILI associated with 5-ASA is rare, reported to be 3.2 cases per million prescriptions [18]. However, the incidence of DILI related to 5-ASA formulations is reported to be relatively low at 0.3-1.0%, accounting for 3.2-11.1% of all 5-ASA AEs [5,12,19,20] and may be underestimated.…”

Section: Discussionmentioning

confidence: 99%

5-Aminosalicylic Acid-Induced Liver Injury in a Patient with Ulcerative Colitis: A Case Report

Watanabe,

Nishida,

Osugi

et al. 2024

Case Rep Gastroenterol

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Introduction: Drug-induced liver injury (DILI) associated with 5-aminosalicylic acid (5-ASA) is a rare but potentially life-threatening adverse event. Case Presentation: We report the case of a 58-year-old woman with ulcerative colitis who developed DILI after initiating maintenance therapy with the multimatrix system 5-ASA. The patient presented with grade 4 liver enzyme elevation on day 98 after initiating 5-ASA and was admitted to the hospital. Blood tests revealed the mixed liver injury, and imaging studies showed no abnormalities except for mild lymph node enlargement. Liver biopsy revealed acute lobular hepatitis with interfacial activity. The patient’s score on the International Autoimmune Hepatitis Group 1999 revised scoring system was a total score of 10, causing a suspicion for the diagnosis of autoimmune hepatitis. The DDW-J 2004 scale calculated a total score of six, indicating a high probability of DILI. We suspected DILI due to 5-ASA, and the 5-ASA formulations were discontinued. The patient was treated with ursodeoxycholic acid and neominophagen C, and her liver function gradually improved without steroid treatment. Finally, we definitively diagnosed DILI based on the pathological findings and clinical course after discontinuation of 5-ASA. Conclusion: This case highlights the importance of monitoring liver function in patients receiving 5-ASA therapy.

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Section: Discussionmentioning

confidence: 99%

5-Aminosalicylic Acid-Induced Liver Injury in a Patient with Ulcerative Colitis: A Case Report

Watanabe,

Nishida,

Osugi

et al. 2024

Case Rep Gastroenterol

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“…On the other hand, it is estimated that clinically apparent liver injury due to mesalazine occurs at an incidence of only 3.2 cases per million prescriptions [5]. In fact, there are less than 10 case reports concerning mesalazine-induced hepatoxicity in literature [6][7][8][9][10][11][12][13][14] (Table 1).…”

Section: Discussionmentioning

confidence: 99%

“…Pineda et al, [6] Hautekeete et al, [7] Stoschus et al, [8] Barroso et al, [9] Deltenre et al, [10] Braun et al, [11] Domínguez Jiménez et al, [12] Stelzer et al, [13] Nihar Shah et al, [14] Disease symptoms and liver enzymes abnormalities, as well as the histopathologic changes observed in the liver biopsy specimen. In addition, the patient's condition was completely resolved by discontinuing the treatment with mesalazine.…”

Section: Table 1 Summary Of Cases Of Mesalazine-induced Hepatoxicity ...mentioning

confidence: 99%

“Hepatotoxicity in inflammatory bowel disease: mesalazine, the forgotten drug”

Garrido

Santos

Lopes

et al. 2021

European Journal of Gastroenterology &Amp; Hepatology

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Introduction Mesalazine is a widely prescribed drug, used for the treatment of ulcerative colitis to both induce and maintain remissions in disease. Mesalazine therapy has been associated with a low rate of serum enzyme elevations and a with rare instances of clinically apparent acute liver injury. Case presentation A 51-year-old Caucasian woman with ulcerative colitis was treated with mesalazine. Two weeks later, the patient presented severe liver cholestatic injury. No symptoms of generalized hypersensitivity were seen. She had no history of liver disease and was known to have normal routine liver tests before starting treatment. The liver biopsy revealed mild periportal necroinflammatory lesions with no fibrosis, suggestive of drug-induced liver injury. The patient’s symptoms were resolved by discontinuing the mesalazine treatment; within 6 months, all her liver panels returned to normal. After extensively excluding other potential causes of liver injury and with clinical and lab resolution after discontinuing the drug, we assumed mesalazine as the cause of hepatic toxicity. Conclusion We describe a patient with ulcerative colitis who developed severe but fully reversible liver cholestatic injury following the prescription of mesalazine. This case reinforces the possibility of a causal relationship between mesalazine therapy and toxic hepatic injury without systemic hypersensitivity. Although it is a usually well-tolerated drug, clinicians should be alert and discontinue therapy when liver dysfunction occurs to avoid the development of chronic hepatitis and liver fibrosis.

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Mesalamine: Good for IBD but Bad for the Liver? A Case of DILI Caused by Mesalamine

Cited by 2 publications

References 0 publications

5-Aminosalicylic Acid-Induced Liver Injury in a Patient with Ulcerative Colitis: A Case Report

5-Aminosalicylic Acid-Induced Liver Injury in a Patient with Ulcerative Colitis: A Case Report

“Hepatotoxicity in inflammatory bowel disease: mesalazine, the forgotten drug”

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