Highlights
- •Liver injury may develop up to 3 months after methylprednisolone (MP) pulse therapy.
- •Liver biopsy in most cases revealed drug-induced acute hepatitis.
- •In only one case, autoimmune hepatitis was triggered by MP pulse therapy.
- •Prognosis was good in most cases except for the one with autoimmune hepatitis.
Abstract
Background
In patients with multiple sclerosis (MS), development of hepatic injury has been sporadically
reported after methylprednisolone (MP) pulse therapy. Some studies suggest autoimmune
hepatitis, while other studies reported direct hepatotoxicity as a cause for hepatic
injury. Here, we studied the pathological mechanism of such liver injury in patients
with MS.
Methods
From 2005 to 2016, eight patients with MS developed liver injury after MP pulse therapy.
Their average age was 38 years (range: 28–49 years, all female). Autoimmune antibodies
were measured and a liver biopsy was performed in seven patients.
Results
Liver injury developed within two weeks in two patients and later (30–90 days after
MP) in six patients. No hepatitis-related autoantibody or hepatitis virus were found.
All cases were classified as hepatocellular injury and none as cholestatic or mixed.
A liver biopsy in five cases revealed centrilobular necrosis with lobular infiltrates
of inflammatory cells, suggesting drug-induced acute hepatitis. The biopsy findings
in another case suggested a residual stage of acute hepatitis. Only one patient showed
portal expansion with periportal fibrosis, suggesting autoimmune hepatitis. All patients
recovered spontaneously or with only hepatoprotective drugs, although one patient
with possible autoimmune hepatitis recovered slowly.
Conclusion
Liver injury develops usually later than two weeks after MP treatment. The prognosis
is good in most cases and rarely autoimmune hepatitis may be involved.
Keywords
Abbreviations:
AIH (autoimmune hepatitis), ALP (alkaline phosphatase), ALT (alanine aminotransferase), AM (Azan Mallory staining), DLST (drug-induced lymphocyte stimulation test), FLAIR (fluid-attenuated inversion recovery), HE (hematoxylin and eosin staining), MP (methylprednisolone), MRI (magnetic resonance imaging), MS (multiple sclerosis)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 23, 2020
Accepted:
March 20,
2020
Received in revised form:
March 16,
2020
Received:
December 17,
2019
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
