TY - JOUR
T1 - Liver injury after methylprednisolone pulses
T2 - A disputable cause of hepatotoxicity. A case series and literature review
AU - Zoubek, Miguel Eugenio
AU - Pinazo-Bandera, Jose
AU - Ortega-Alonso, Aida
AU - Hernandez, Nelia
AU - Crespo, Javier
AU - Contreras, Fernando
AU - Medina-Caliz, Inmaculada
AU - Sanabria-Cabrera, Judith
AU - Sanjuan-Jimenez, Rocio
AU - Gonzalez-Jimenez, Andres
AU - Garcia-Cortes, Miren
AU - Isabel Lucena, M.
AU - Andrade, Raul J.
AU - Robles-Diaz, Mercedes
N1 - Funding Information:
This work was supported by ISCiii-Fondos FEDER (PI18-01804, PI18-00901, PT17/0017/0020, JR16/00015, CM17/ 00243); CS-SAS (PI-0274/2016, PI-0285-2016); and AEMPS.
Publisher Copyright:
© Author(s) 2019.
PY - 2019/7
Y1 - 2019/7
N2 - 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.
AB - 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.
KW - Methylprednisolone-induced liver injury
KW - steroid pulses
KW - multiple sclerosis
KW - Graves' ophthalmopathy
KW - AIH
KW - HIGH-DOSE METHYLPREDNISOLONE
KW - AUTOIMMUNE HEPATITIS
KW - MULTIPLE-SCLEROSIS
KW - INTRAVENOUS METHYLPREDNISOLONE
KW - THERAPY
KW - PATIENT
KW - TOXICITY
KW - OPHTHALMOPATHY
KW - FAILURE
U2 - 10.1177/2050640619840147
DO - 10.1177/2050640619840147
M3 - (Systematic) Review article
C2 - 31316787
SN - 2050-6406
VL - 7
SP - 825
EP - 837
JO - United European Gastroenterology Journal
JF - United European Gastroenterology Journal
IS - 6
ER -