Recurrent acute hepatitis in patient receiving pulsed methylprednisolone for multiple sclerosis

Area of Science:

• Hepatology
• Clinical Pharmacology
• Immunology

Background:

• Multiple sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system.
• Pulsed methylprednisolone therapy is a common treatment for MS exacerbations.
• Drug-induced liver injury (DILI) can manifest with various clinical and histological patterns.

Observation:

• A 48-year-old woman experienced recurrent episodes of clinically significant acute hepatitis.
• These episodes occurred during pulsed treatment with methylprednisolone for multiple sclerosis.
• Extensive investigations ruled out other potential causes for the hepatitis.

Findings:

• The temporal relationship between methylprednisolone administration and hepatitis onset was noted.
• Histological findings were consistent with an immune-allergic mechanism of liver injury.
• The clinical presentation and laboratory findings strongly suggested drug-induced hepatitis.

Implications:

• This case highlights the potential for methylprednisolone to cause immune-allergic drug-induced hepatitis.
• Clinicians should consider DILI in patients with unexplained hepatitis during corticosteroid therapy.
• Further research may be warranted to elucidate the specific immune mechanisms involved in methylprednisolone-induced liver injury.