Miguel Eugenio Zoubek1,2, José Pinazo-Bandera1, Aida Ortega-Alonso1, Nelia Hernández3, Javier Crespo4,5, Fernando Contreras6, Inmaculada Medina-Cáliz1, Judith Sanabria-Cabrera1,7, Rocío Sanjuan-Jiménez1,7, Andrés González-Jiménez1, Miren García-Cortés1, M Isabel Lucena1,7,5, Raúl J Andrade1,5, Mercedes Robles-Díaz1,5. 1. UGC Digestivo y Farmacología Clínica, Instituto de Investigación Biomédica de Málaga (IBIMA), H U Virgen de la Victoria, Malaga, Spain. 2. Department of Toxicology, School for Nutrition, Toxicology and Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands. 3. Hospital de Clínicas, Clínica Gastroenterología, F Medicina, Montevideo, Uruguay. 4. Unidad de Gestión Clínica de Enfermedades Digestivas, Hospital Marqués de Valdecilla, Instituto de Investigación Biomédica Marques de Valdecilla (IDIVAL), Santander, Spain. 5. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, CIBERehd, Madrid, Spain. 6. Departamento de Gastroenterología, National University Pedro Henríquez Ureña, Santo Domingo, Dominican Republic. 7. Unidad Investigación Clínica y Ensayos ClÚcos (UICEC)-Instituto de Investigacióe Biomedicina de Málaga (IBIMA), Plataforma Spanish Clinical Research Network (SCReN), Málaga Spain.
Abstract
Background and Objectives: Corticosteroids are often empirically used to treat idiosyncratic hepatotoxicity with severe features. Interestingly, intravenous methylprednisolone (MP) is increasingly being recognized as being responsible for liver injury. We aimed to characterize MP-induced liver injury by analyzing demographical, clinical, laboratory and outcome data of three MP-induced hepatotoxicity cases and compared this information with that of previously published cases. Case series: Three females with multiple sclerosis (MS) were treated intravenously with MP, mean daily dose 767 mg. Liver damage occurred 2 to 6 weeks after exposure. Severity was mild to moderate. Two patients suffered positive rechallenge. Literature review: We identified 50 published cases of MP hepatotoxicity. Most of these cases were female (86%) and main treatment indications were MS (29 cases) and Graves' ophthalmopathy (13 cases). Hepatocellular damage predominated and mean time to onset was 6 weeks. Four patients died and rechallenge occurred in 19 cases. Conclusion: MP pulses can induce severe liver injury, often with an autoimmune phenotype, particularly in patients with MS and Graves' ophthalmopathy. Consequently, these patient groups should have liver tests monitored when treated with MP to provide safer patient care.
Background and Objectives: Corticosteroids are often empirically used to treat idiosyncratic hepatotoxicity with severe features. Interestingly, intravenous methylprednisolone (MP) is increasingly being recognized as being responsible for liver injury. We aimed to characterize MP-induced liver injury by analyzing demographical, clinical, laboratory and outcome data of three MP-induced hepatotoxicity cases and compared this information with that of previously published cases. Case series: Three females with multiple sclerosis (MS) were treated intravenously with MP, mean daily dose 767 mg. Liver damage occurred 2 to 6 weeks after exposure. Severity was mild to moderate. Two patients suffered positive rechallenge. Literature review: We identified 50 published cases of MP hepatotoxicity. Most of these cases were female (86%) and main treatment indications were MS (29 cases) and Graves' ophthalmopathy (13 cases). Hepatocellular damage predominated and mean time to onset was 6 weeks. Four patients died and rechallenge occurred in 19 cases. Conclusion:MP pulses can induce severe liver injury, often with an autoimmune phenotype, particularly in patients with MS and Graves' ophthalmopathy. Consequently, these patient groups should have liver tests monitored when treated with MP to provide safer patient care.
Authors: Raúl J Andrade; M Isabel Lucena; M Carmen Fernández; Gloria Pelaez; Ketevan Pachkoria; Elena García-Ruiz; Beatriz García-Muñoz; Rocio González-Grande; Angeles Pizarro; José Antonio Durán; Manuel Jiménez; Luis Rodrigo; Manuel Romero-Gomez; José María Navarro; Ramón Planas; Joan Costa; Africa Borras; Aina Soler; Javier Salmerón; Rafael Martin-Vivaldi Journal: Gastroenterology Date: 2005-08 Impact factor: 22.682
Authors: Mercedes Robles-Diaz; M Isabel Lucena; Neil Kaplowitz; Camilla Stephens; Inmaculada Medina-Cáliz; Andres González-Jimenez; Eugenia Ulzurrun; Ana F Gonzalez; M Carmen Fernandez; Manuel Romero-Gómez; Miguel Jimenez-Perez; Miguel Bruguera; Martín Prieto; Fernando Bessone; Nelia Hernandez; Marco Arrese; Raúl J Andrade Journal: Gastroenterology Date: 2014-04-01 Impact factor: 22.682
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