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Updated: Jul 5, 2025
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Human Liver Microphysiological System for Assessing Drug-Induced Liver Toxicity In Vitro
Published on: January 31, 2022
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Mesalamine induced hepatotoxicity. Is mesalamine safe?
Javier Pérez-Valenzuela1, Lorena Castro Solari2, Rodrigo Quera3
1Internal Medicine , Universidad de los Andes, Chile.
Revista Espanola De Enfermedades Digestivas
|January 11, 2024
Summary
Mesalamine, used for inflammatory bowel disease, can cause liver injury. This case highlights a 79-year-old woman who developed cholestatic hepatotoxicity, confirmed by biopsy, after starting mesalamine treatment.
Area of Science:
- Gastroenterology
- Hepatology
- Pharmacology
Background:
- Mesalamine is a first-line treatment for inflammatory bowel disease (IBD), including ulcerative colitis.
- While generally safe, mesalamine-induced hepatotoxicity is a rare but recognized adverse effect, occurring in 0-4% of patients.
Observation:
- A 79-year-old female with left-sided ulcerative colitis developed symptoms including headache, fatigue, and low-grade fever three months after initiating oral and suppository mesalamine therapy.
- Initial liver tests revealed a cholestatic pattern and elevated inflammatory markers. Cholangioresonance showed bile duct dilation and thickening without obstruction.
Findings:
- Liver biopsy confirmed chronic non-suppurative cholangitis with granulomas and focal concentric fibrosis.
- The findings were related to medium-caliber bile ducts, and IgG4 staining was negative, ruling out IgG4-related sclerosing cholangitis.
Implications:
- This case underscores the importance of considering mesalamine-induced hepatotoxicity in IBD patients presenting with liver abnormalities.
- Prompt recognition and discontinuation of mesalamine are crucial for managing this rare adverse event and preventing disease progression.
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