Methyldopa-induced liver injury. Rapid progression to fatal postnecrotic cirrhosis

A 55-year-old woman developed symptoms suggestive of hepatitis 12 weeks after first receiving methyldopa for hypertension. Liver biopsy showed chronic aggressive hepatitis with subacute hepatic necrosis. Methyldopa was discontinued, but after exhibiting transient clinical improvement, the patient's condition progressively deteriorated until she died of hepatic failure, in spite of therapy with massive doses of corticosteroids and other nonspecific measures. During the terminal stage, a considerable decrease in the size of the liver was observed. At autopsy, the liver was found to be small, shrunken, and scarred; histological sections demonstrated postnecrotic cirrhosis. Such a rapid and relentless progression of methyldopa-induced liver injury is undoubtedly rare, but it may be prevented by careful supervision of patients who exhibit liver function abnormalities early in the course of therapy.