Liver injury after methylprednisolone pulses: A disputable cause of hepatotoxicity. A case series and literature review
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2019-02-17Autor
Zoubek, Miguel Eugenio
Pinazo Bandera, José
Ortega Alonso, Aida
Hernández, Nelia
Crespo, Javier
Contreras, Fernando
Medina Cáliz, Inmaculada
Sanabria Cabrera, Judith
Sanjuan Jiménez, Rocìo
González Jiménez, Andrés
García Cortés, Miren
Lucena, M Isabel
Andrade, Raúl J
Robles Díaz, Mercedes
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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.
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