title: Induced liver injury after high-dose methylprednisolone in a patient with multiple sclerosis.
abstract: A 33-year-old woman with multiple sclerosis, medicated with high doses of methylprednisolone, cyclophosphamide and glatiramer acetate, was referred to our department due to acute liver injury. The laboratory investigation was normal except for weakly positive antinuclear antibodies. Cyclophosphamide and glatiramer acetate were suspended, and intravenous immunoglobulin with maintenance of high doses of methylprednisolone was initiated. The patient developed another episode of acute hepatitis so the immunoglobulin was stopped. After that, she had three more episodes of elevation of liver enzymes with no hepatic insufficiency while medicated only with high doses of methylprednisolone. At this time, liver biopsy showed focal centrilobubar hepatocyte necrosis with minimal interface hepatitis. After the high doses of methylprednisolone were suspended, the patient remained asymptomatic, with normal hepatic enzymes. This case emphasises that, although rare, induced liver injury after high doses of methylprednisolone can occur.
authors.affiliation: Department of Gastroenterology, Coimbra University Hospital, Coimbra, Portugal.
authors.forename: Ana Torres
authors.initials: AT
authors.lastname: Oliveira
authors.affiliation: Department of Gastroenterology, Coimbra University Hospital, Coimbra, Portugal.
authors.forename: Sandra
authors.initials: S
authors.lastname: Lopes
authors.affiliation: Department of Pathology, Coimbra University Hospital, Coimbra, Portugal.
authors.forename: Maria Augusta
authors.initials: MA
authors.lastname: Cipriano
authors.affiliation: Department of Gastroenterology, Coimbra University Hospital, Coimbra, Portugal.
authors.forename: Carlos
authors.initials: C
authors.lastname: Sofia
mesh_terms: D000208:Acute Disease; D000328:Adult; D001706:Biopsy; D056486:Chemical and Drug Induced Liver Injury / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D000068717:Glatiramer Acetate / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006505:Hepatitis / Q000097:blood* / Q000473:pathology; D006801:Humans; D007136:Immunoglobulins / Q000008:administration & dosage / Q000009:adverse effects; D008099:Liver / Q000473:pathology*; D008111:Liver Function Tests; D008775:Methylprednisolone / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D009103:Multiple Sclerosis / Q000188:drug therapy*
chemical_list: D007136:Immunoglobulins; D000068717:Glatiramer Acetate; D003520:Cyclophosphamide; D008775:Methylprednisolone