A rare case of methylprednisolone induced hepatitis

Introduction: Drugs are known to be an important etiological factor of acute hepatitis. Corticosteroids have been considered relatively safe in this regard. However, cases of acute hepatotoxicity induced by methylprednisolone have been reported.We present a case of a 38 year old lady who developed acute hepatitis following treatment with oral Methylprednisolone for interstitial lung disease.Case Report:A 38 year old lady presented with insidious, gradually progressive jaundice associated with an urticarial rash and pruritis following treatment of ILD with Methylprednisolone 16mg BD for 30 days.Upon admission, her labs revealed total bilirubin: 3.32 mg/dl with direct: 1.33 mg/dl, AST: 1428 U/L, ALT: 2618 U/L, alkaline phosphatase: 134 U/L, albumin: 3.2 gm/dl and INR: 1.36. Blood counts including Absolute Eosinophil count were normal. Viral serology, autoimmune markers and Wilson's workup were negative. Ultrasound abdomen and Doppler study were normal. Liver biopsy showed features of cholestatic hepatitis with early fibrosis. Her liver function improved with supportive management. There was no relapse on discontinuation of steroids. LFT was normal at 6 months of follow-up.Discussion: We report a case of hepatotoxicity related to oral Methylprednisolone treatment with CIOMS/RUCAM causality score of 8. We identified 13 case reports of methylprednisolone induced hepatotoxicity on literature review. In this patient, AIH-DILI was considered, however the acute onset, temporal relationship, absence of relapse after steroid withdrawal, negative autoimmune markers and liver biopsy findings were in favor of drug induced hepatitis.Conclusion: We report a case of Methylprednisolone induced liver injury. We believe that the awareness of this adverse drug reaction has to be created. Introduction: Drugs are known to be an important etiological factor of acute hepatitis. Corticosteroids have been considered relatively safe in this regard. However, cases of acute hepatotoxicity induced by methylprednisolone have been reported.We present a case of a 38 year old lady who developed acute hepatitis following treatment with oral Methylprednisolone for interstitial lung disease. Case Report:A 38 year old lady presented with insidious, gradually progressive jaundice associated with an urticarial rash and pruritis following treatment of ILD with Methylprednisolone 16mg BD for 30 days.Upon admission, her labs revealed total bilirubin: 3.32 mg/dl with direct: 1.33 mg/dl, AST: 1428 U/L, ALT: 2618 U/L, alkaline phosphatase: 134 U/L, albumin: 3.2 gm/dl and INR: 1.36. Blood counts including Absolute Eosinophil count were normal. Viral serology, autoimmune markers and Wilson's workup were negative. Ultrasound abdomen and Doppler study were normal. Liver biopsy showed features of cholestatic hepatitis with early fibrosis. Her liver function improved with supportive management. There was no relapse on discontinuation of steroids. LFT was normal at 6 months of follow-up. Discussion: We report a case of hepatotoxicity related to oral Methylprednisolone treatment with CIOMS/RUCAM causality score of 8. We identified 13 case reports of methylprednisolone induced hepatotoxicity on literature review. In this patient, AIH-DILI was considered, however the acute onset, temporal relationship, absence of relapse after steroid withdrawal, negative autoimmune markers and liver biopsy findings were in favor of drug induced hepatitis. Conclusion: We report a case of Methylprednisolone induced liver injury. We believe that the awareness of this adverse drug reaction has to be created.