Methylprednisolone-induced acute liver injury in a patient treated for multiple sclerosis relapse

Drug-induced liver injury is the fourth most common cause of liver disease in industrialised countries. Methylprednisolone is often considered to be a treatment with a low hepatotoxicity. We report a case of methylprednisolone-induced liver injury in a 35-year-old woman. She was admitted to our department for acute liver injury 2 months after a treatment with high dose of methylprednisolone (1 g/day) for a multiple sclerosis relapse. No other cause of liver injury could be found (screening for hepatotropic viruses, autoimmune antibodies, ceruloplasmin, abdominal ultrasonography and liver biopsy). Liver function tests spontaneously improved and returned to normal range within 6 weeks. We also performed a brief review of the literature and identified 12 other cases of methylprednisolone-induced liver injury in patients treated for multiple sclerosis relapse. An immune rebound phenomenon could be responsible for rare but true hepatotoxicity of high-dose methylprednisolone therapy.