A 57-year-old woman diagnosed at 44 years of age with multiple sclerosis (MS) who received 3 courses of 6-methylprednisolone at a dose of 1,000 mg intravenously (i.v.) given as a "push" ME
The patient previously had a rigorously normal liver test, did not recognize habitual alcohol intake and did not take potentially hepatotoxic drugs.
After 3 days of receiving the last 6-methylprednisolone i. v. pulse, there was the following change in liver profile at the time of routine analysis:
12 months later the patient experienced a new episode of exacerbation of her MS and was re-treated with a 3 bolus cycle of 6-methylprednisolone (1 g/day i.v. normalisation of liver profile for 3 days)
27 months after the second exposure, he again received 3-day boluses of 6-methylprednisolone i. v. at the same doses, with a new episode of asymptomatic elevation of hepatic enzymes UGT85:
The summary of the evolution of the patient's analytical parameters is presented in Figure 1.
1.
During the acute phase of these hepatic biochemistry alteration, HBV serology (HBsAg, HBcAc IgM), HCV (PCR, anti-HCV, anti-HCV-antinuclear antibodies and anti-RNAL IgM) were determined.
Serum copper and ceruloplasmin, together with 24-hour urine cupruria, ferritin, TSH and α1-antitrypsin were within normal range.
Abdominal ultrasound in relation to the three episodes of hepatic biochemistry alteration showed no pathological findings.
One month after detection of the last acute hepatitis bud, it was decided to perform a liver biopsy in which histological lesions characteristic of acute hepatitis with presence of lytic necrosis and macrophage hyperplasia with ceroid were identified.
1.
The combination of clinical, analytical and histological data, once other causes of potential alteration of the hepatic profile were excluded, suggested the diagnosis of recurrent acute hepatitis secondary to intravenous methylprednisolone.
