α-Methyldopa-induced hepatitis during the postpartum period

Abstract

A 34-year-old woman, with a history of pre-eclampsia, was diagnosed with α-methyldopa-induced hepatotoxicity, after she presented with severe jaundice and hepatitis 8 weeks following delivery. Laboratory investigations and liver biopsy ruled out other causes of hepatitis. She continued to improve clinically after cessation of α-methyldopa, and was discharged 10 days after admission. This case report emphasises that it may not be possible to predict which patients may develop α-methyldopa-induced hepatitis, hence regular monitoring of liver function tests during treatment should be implemented.

Drug-induced liver injury in early pregnancy associated with methyldopa administration during antihypertensive therapy

“…Additional symptoms that may occur in patients include pruritus, rash, lymphadenopathy, arthralgia and myalgia [1]. However, hepatic disorder can have a subclinical course with only isolated elevation of biochemical markers of liver injury, as in the described case [2]. On the contrary, hepatic dysfunction may lead to life-threatening conditions [11].…”

“…α-Methyldopa is considered to be a safe and well-tolerated drug without any influence on fetal hemodynamics and placental circulation [2,7]. The initial dose is 250 mg 2-3 times a day during the first two days.…”

“…It is necessary to perform imaging examination of the abdominal cavity. Abdominal ultrasound examination is usually the first-line examination, yet it rarely reveals any abnormalities [2,11]. Sometimes it is necessary to extend the diagnostics to more specific imaging diagnostics such as computed tomography scan or magnetic resonance imaging [6].…”

“…In blood tests, besides the biochemical markers of liver damage, it is also important to monitor the parameters of the coagulation system [1,4]. In some patients, in addition to elevated transaminases or cholestasis parameters we can observe eosinophilia, prolonged prothrombin time and increased level of immunoglobulins [1,2]. A liver biopsy performed in some patients showed focal necrosis, infiltration of inflammatory cells, proliferation of the bile ducts, microscopic features of cholestasis or liver cirrhosis, but in several cases no changes were found in histopathological examination [12].…”

“…α-Methyldopa is one of the most common antihypertensive drugs used during pregnancy [1]. It is considered to be safe for the neonate and well tolerated by the woman [1,2]. We present a case of drug-induced liver injury in a woman at 11 weeks' gestation who developed this rare complication as a result of methyldopa therapy.…”