Toxic liver injury after high-dose methylprednisolone in people with multiple sclerosis

Adamec, Ivan; Pavlović, Ivan; Pavičić, Tin; Ruška, Berislav; Habek, Mario

doi:10.1016/j.msard.2018.07.021

Cited by 10 publications

(9 citation statements)

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“…To date a limited number of cases of methylprednisolone-induced hepatotoxicity had been described 7 10–24. We report an idiosyncratic toxic hepatitis from high-dose methylprednisolone in a 16-year-old girl.…”

Section: Discussionmentioning

confidence: 91%

“…Liver injury caused by corticosteroids varied from asymptomatic hypertransaminasaemia to fulminant hepatic failure 10–24. Acute presentations include mild liver test abnormalities, cholestasis with pruritus, and sometimes acute liver failure mimicking aggressive conditions such as viral hepatitis.…”

Section: Discussionmentioning

confidence: 99%

“…However, perhaps not everyone knows the toxic damages to the liver due to methylprednisolone. Hepatotoxicity from HDCS had been described 7 10–24. This condition was related to immunomodulator drugs, autoimmune or viral agents, until recently when the relation between methylprednisolone therapy and hepatotoxicity had been proven 21 25.…”

Section: Introductionmentioning

confidence: 99%

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Methylprednisolone-induced hepatotoxicity in a 16-year-old girl with multiple sclerosis

et al. 2018

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Multiple sclerosis (MS) is a chronic inflammatory disease with demyelination of the central nervous system. High-dosage corticosteroids are the first-line therapy in the acute relapsing of MS. We report a case of severe high-dose methylprednisolone-induced acute hepatitis in a patient with a new diagnosis of MS. A 16-year-old girl was admitted for urticaria, angioedema, nausea and vomiting a month later she had been diagnosed with MS and treated with high-dosage methylprednisolone. Laboratory investigations showed hepatic insufficiency with grossly elevated liver enzymes. A liver biopsy showed focal centrilobular hepatocyte necrosis with interface hepatitis. Methylprednisolone-induced hepatotoxicity can confuse the clinical picture of patients with MS and complicate the differential diagnosis. We believe that each specialist should know it and monitor patients with MS taking high doses of methylprednisolone. As there is no screening model that predicts idiosyncratic hepatotoxicity, we promote screening for potential liver injury following pulse steroid therapy.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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Methylprednisolone-induced hepatotoxicity in a 16-year-old girl with multiple sclerosis

et al. 2018

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“…It is worth noting that patients 11, 14, 43 and 48 responded favourably to dexamethasone therapy, with no subsequent flares in transaminases or only mild liver dysfunction (case 43). Thus, dexamethasone might be a safe glucocorticoid alternative in patients with a previous episode of MP‐DILI 13 , 32 …”

Section: Discussionmentioning

confidence: 99%

“…A total number of 50 cases presented in 7 case series and 24 single case reports were retrieved from 2000 to 2018, carefully reviewed and analyzed in this study (Tables 1 and 2). 4–34…”

Section: Case Seriesmentioning

confidence: 99%

Liver injury after methylprednisolone pulses: A disputable cause of hepatotoxicity. A case series and literature review

et al. 2019

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Background and Objectives Corticosteroids are often empirically used to treat idiosyncratic hepatotoxicity with severe features. Interestingly, intravenous methylprednisolone (MP) is increasingly being recognized as being responsible for liver injury. We aimed to characterize MP-induced liver injury by analyzing demographical, clinical, laboratory and outcome data of three MP-induced hepatotoxicity cases and compared this information with that of previously published cases. Case series Three females with multiple sclerosis (MS) were treated intravenously with MP, mean daily dose 767 mg. Liver damage occurred 2 to 6 weeks after exposure. Severity was mild to moderate. Two patients suffered positive rechallenge. Literature review We identified 50 published cases of MP hepatotoxicity. Most of these cases were female (86%) and main treatment indications were MS (29 cases) and Graves' ophthalmopathy (13 cases). Hepatocellular damage predominated and mean time to onset was 6 weeks. Four patients died and rechallenge occurred in 19 cases. Conclusion MP pulses can induce severe liver injury, often with an autoimmune phenotype, particularly in patients with MS and Graves' ophthalmopathy. Consequently, these patient groups should have liver tests monitored when treated with MP to provide safer patient care.

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Multiple drugs

2018

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Toxic liver injury after high-dose methylprednisolone in people with multiple sclerosis

Cited by 10 publications

References 7 publications

Methylprednisolone-induced hepatotoxicity in a 16-year-old girl with multiple sclerosis

Methylprednisolone-induced hepatotoxicity in a 16-year-old girl with multiple sclerosis

Liver injury after methylprednisolone pulses: A disputable cause of hepatotoxicity. A case series and literature review

Multiple drugs

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