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Methylprednisolone-induced Toxic Hepatitis After Intravenous Pulsed Therapy for Multiple Sclerosis Relapses

Diana Ferraro1, Vincenzo G Mirante, Luisa Losi

  • 1*Neurology Unit, Department of Neurosciences ‡Pathology Institute §Gastroenterology Unit, University of Modena and Reggio Emilia †Internal Medicine and Gastroenterology Unit, Nuovo Ospedale Civile Sant'Agostino Estense, Modena, Italy.

The Neurologist
|June 16, 2015
PubMed

Insights

High-dose intravenous methylprednisolone (MP) can cause liver damage in multiple sclerosis patients. This potentially lethal adverse reaction may be more common than previously recognized.

Area of Science:

  • Neurology
  • Hepatology
  • Clinical Pharmacology

Background:

  • Intravenous methylprednisolone (MP) is a standard first-line therapy for multiple sclerosis (MS) relapses.
  • Concerns exist regarding potential liver toxicity associated with this treatment.

Observation:

  • Four multiple sclerosis patients without pre-existing liver conditions or risk factors developed elevated liver enzymes after IV MP treatment.
  • Liver biopsies in two patients revealed significant histological changes, including fibrosis and necrosis.

Findings:

  • A causal link between MP administration and hypertransaminasaemia was confirmed in one patient via rechallenge.
  • Hepatotoxicity is a potential adverse effect of high-dose intravenous MP therapy in MS patients.

Implications:

  • Increased awareness of MP-induced liver toxicity is crucial for clinicians managing MS patients.
  • Monitoring liver function may be warranted during or after corticosteroid pulse therapy.
  • This highlights the importance of reporting potentially lethal adverse drug reactions.

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