[Recurrent acute liver toxicity from intravenous methylprednisolone]

Area of Science:

• Hepatology
• Clinical Pharmacology
• Neurology

Background:

• Adverse drug reactions are a significant cause of acute liver injury.
• Early recognition of drug-induced liver disease is crucial for patient management.
• Steroids are commonly used, but intravenous formulations are rarely linked to hepatotoxicity.

Observation:

• A middle-aged woman with multiple sclerosis experienced recurrent elevated liver enzymes after receiving intravenous methylprednisolone.
• The patient underwent three separate treatment courses with methylprednisolone for relapsing disease.
• Liver enzyme elevations occurred repeatedly following corticoid administration.

Findings:

• A liver biopsy during the third episode revealed acute hepatitis with bridging necrosis.
• This specific histological finding has not been previously documented in patients treated with intravenous steroids.
• The case suggests a potential, albeit rare, hepatotoxic effect of intravenous methylprednisolone.

Implications:

• This case expands the known spectrum of potential adverse drug reactions associated with intravenous steroid therapy.
• It underscores the importance of considering drug-induced liver injury even with medications not typically associated with hepatotoxicity.
• Further investigation may be warranted to understand the mechanisms and frequency of this rare complication.