Bolus de méthylprednisolone révélant une hépatite auto-immune chez une patiente atteinte de sclérose en plaques

Liver injury after pulsed methylprednisolone therapy in multiple sclerosis patients

“…In case of severe methylprednisolone‐related liver injury, a careful hepatic workup is warranted in order to accurately attribute the responsibility of the toxic effect to the drug rather than to the an ex novo onset of autoimmune hepatitis (Carrier et al., ; Maàmouri et al., ; Reuβ et al., ; Salvi et al., ; Takahashi et al., ). In our cohort, three patients received a final diagnosis of probable or definite autoimmune hepatitis (patients 2, 3, and 5) and their baseline clinical characteristics were almost indistinguishable from those of patients who received a final diagnosis of DILI..…”

“…High-dose pulsed methylprednisolone treatment has been also associated with liver injury. By reviewing the literature published in English, we found a total of forty-seven cases of methylprednisolonerelated liver injury, including patients treated for diseases other than MS (Carrier et al, 2013;D'Agnolo & Drenth, 2013;Das, Graham, & Rose, 2006;Davidov et al, 2016;Dourakis, Sevastianos, & Kaliopi, 2002;Dumortier et al, 2017;Eguchi et al, 2015;Ferraro et al, 2015;Furutama et al, 2011;Gerolami et al, 1997;Grilli, Galati, Petrosillo, Del Nonno, & Baiocchini, 2015;Gutkowski, Chwist, & Hartleb, 2011;Hidalgo de la Cruz et al, 2017;Hofstee, Nanayakkara, & Stehouwer, 2005;Loraschi et al, 2010;Maàmouri et al, 2009;Marinó et al, 2004;Melamud, Lurie, Goldin, Levi, & Esayag, 2014;Moleti et al, 2016;Nanki, Koike, & Miyasaka, 1999;Oliveira, Lopes, Cipriano, & Sofia, 2015;Reuβ, Retzlaff, Vogel, Franke, & Oschmann, 2007;Rivero Fernández et al, 2008;Salvi et al, 2004;Takahashi et al, 2008;Topal et al, 2006;Weissel & Hauff, 2000). The aim of this prospective study was to evaluate the prevalence, severity, and risk factors for liver injury in patients affected by MS treated with pulsed methylprednisolone.…”

Methylprednisolone‐induced liver injury: Case report and literature review

“…DILI may be classified into the following subtypes: (i) a predictable dose‐related occurrence; (ii) an unpredictable idiosyncratic reaction; and (iii) an immune‐mediated hypersensitivity response . DILI due to high‐dose MT therapy is a rare adverse reaction . It is thought to be an idiosyncratic reaction to steroids and their metabolites, or be due to the compounds used as preservatives .…”

“…Based on our literature review through PubMed, we identified 15 case reports and two case series (25 cases in total, including the case presented here) of MT‐induced DILI that were reported between 2000 and 2015 (Table ) . Most of the patients are middle‐aged women with a median age of 43 years (range 11–71 years).…”

“…1 With regard to the treatment, steroids are usually safe as far as hepatotoxicity is concerned; moreover, they are also the treatment of choice for autoimmune hepatitis (AIH). While reported methylprednisolone (MT)induced hepatotoxicity is rare, [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] it may cause severe liver injury that recurs with repeated administrations, leading to a poor outcome. 10,15 A timely recognition of this complication and early withdrawal of the drug may prevent the progression of hepatic injury.…”