Methylprednisolone-induced hepatotoxicity
A case report
Abstract
Introduction: drug induced hepatotoxicity and toxicity induced by other agents is a frequent form of liver injury, accounting for larger number of cases than viral
hepatitis in some countries. Presentation may be variable, from an isolated alteration in the liver function test to severe forms of acute fulminant liver failure. The
study presents a case of severe liver injury following a short cycle with high doses of intravenous methylprednisolone.
Clinical case: 45 year-old female patient. Personal history of multiple sclerosis, with relapse 40 days prior to the consultation, treated with intravenous methylprednisolone.
The patient consulted for jaundice with one week of evolution, abdominal pain, vomiting, anorexia, asthenia, and adynamia in the last month. Paraclinical tests find mixed hyperbilirubinemia, increased transaminases and decreased prothrombin time (PT). Viral, autoimmune and metabolic etiology are ruled out and a hypothesis is made for methylprednisolone-induced hepatotoxicity. The latter is confirmed and evolution is favorable, liver enzymogram being normal after three months, the same as the prothrombin time upon the interruption of methylprednisolone therapy.
Discussion: the first step to diagnose hepatotoxicity is excluding other causes of liver injury. Next, the temporal relationship between drug exposure and liver injury needs to be demonstrated. Last, withdrawing the drug is usually accompanied by clinical and tests improvement. A high degree of suspicion is necessary to diagnose this condition. Therapies with high doses of methylprednisolone may cause severe hepatitis, and it is recurrent upon re-exposure to the drug. Patients with autoimmune diseases have greater risks of developing hepatotoxicity, what results in a therapeutic challenge.
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