title: Methylprednisolone-induced Toxic Hepatitis After Intravenous Pulsed Therapy for Multiple Sclerosis Relapses.
abstract: High-dose, intravenous methylprednisolone (MP) is the only recommended first-line treatment for multiple sclerosis relapses. However, there are increasing reports on liver toxicity induced by this treatment regimen. We report of 4 multiple sclerosis patients with no history of viral/metabolic liver disorders or alcohol/hepatotoxic drug intake, who developed hypertransaminasaemia following intravenous MP. In 2 of the patients, liver biopsy showed periportal fibrosis, piecemeal necrosis, and inflammatory cell infiltrates. A rechallenge test confirmed a causal association in 1 case. MP-induced liver toxicity may be more frequent than commonly thought and it is important to report this adverse reaction, which is potentially lethal, and to raise awareness on the potential hepatotoxicity of corticosteroid pulses.
authors.affiliation: *Neurology Unit, Department of Neurosciences ‡Pathology Institute §Gastroenterology Unit, University of Modena and Reggio Emilia †Internal Medicine and Gastroenterology Unit, Nuovo Ospedale Civile Sant'Agostino Estense, Modena, Italy.
authors.forename: Diana
authors.initials: D
authors.lastname: Ferraro
authors.forename: Vincenzo G
authors.initials: VG
authors.lastname: Mirante
authors.forename: Luisa
authors.initials: L
authors.lastname: Losi
authors.forename: Erica
authors.initials: E
authors.lastname: Villa
authors.forename: Anna M
authors.initials: AM
authors.lastname: Simone
authors.forename: Francesca
authors.initials: F
authors.lastname: Vitetta
authors.forename: Lucia
authors.initials: L
authors.lastname: Federzoni
authors.forename: Paolo F
authors.initials: PF
authors.lastname: Nichelli
authors.forename: Patrizia
authors.initials: P
authors.lastname: Sola
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008775:Methylprednisolone / Q000008:administration & dosage* / Q000009:adverse effects*; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000188:drug therapy*; D020551:Pulse Therapy, Drug; D055815:Young Adult
chemical_list: D008775:Methylprednisolone