Drug-induced liver injury after high-dose methylprednisolone: clinical case

We present a clinical case of acute hepatitis confirmed by liver biopsy. A 24-year-old patient underwent pulse therapy with methylprednisolone due to the onset of multiple sclerosis. The liver enzyme values were within the normal range 15 days later. Blood tests revealed the development of cytolysis syndrome during an unrelated medical examination two months later. Obvious causes of hepatitis were excluded, and liver biopsy was performed to verify the diagnosis. The biopsy showed a picture of acute hepatitis with high histological activity and development of submassive necrosis. The situation was interpreted as drug-induced liver injury after pulse therapy with methylprednisolone. Oral prednisone therapy was prescribed, and the inflammation and liver injury were reverted. The presented clinical case highlights the importance of follow-up of patients receiving high doses of methylprednisolone.