Dumortier Jérôme, Cottin Judith, Lavie Caroline, Guillaud Olivier, Hervieu Valérie, Chambon-Augoyard Christine, Scoazec Jean-Yves, Vukusic Sandra, Vial Thierry
Service d'Hépato-gastro-entérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard Lyon 1, Lyon, France.
Centre de Pharmacovigilance, Service Hospitalo-Universitaire de Pharmacotoxicologie, Hospices Civils de Lyon, Lyon, France.
Clin Res Hepatol Gastroenterol. 2017 Sep;41(4):497-501. doi: 10.1016/j.clinre.2017.03.008. Epub 2017 Apr 21.
Reported hepatotoxicity induced by corticosteroids is very rare, and the diagnosis is highly challenging in the context of auto-immune disease. We report here a case of high-dose methylprednisolone (MP)-induced acute hepatitis confirmed by liver histology in a patient with multiple sclerosis (MS) and a case series (n=4) notified to the French Pharmacovigilance center of Lyon. In all 5 cases, other common causes of hepatitis were excluded. The causal relationship with MP pulse therapy was supported by the fact that MP was the only culprit drug. In addition, 3 of these 5 patients underwent unintended single or multiple positive MP rechallenge. Our 5 patients scored a RUCAM score from 6 (probable) to 10 (highly probable). MP-induced liver injury is probably very rare, since only less than 30 cases have been reported in the literature. Nevertheless, our cases strongly illustrates that many cases could have been unrecognized; final diagnosis in 3 of 5 of our patients was made after the second or third episode of acute hepatitis. In conclusion, these cases we report here strongly illustrates that high-dose MP-induced liver injury can occur in patients treated for MS or auto-immune disorder. Unintended re-challenge can confirm the diagnosis and can help to distinguish it from autoimmune hepatitis. Performing liver function tests routinely both before and after MP administration would be beneficial, as the timely recognition of this complication and early drug withdrawal may prevent progression of severe necrosis hepatic injury.
据报道，皮质类固醇引起的肝毒性非常罕见，在自身免疫性疾病的背景下诊断极具挑战性。我们在此报告一例经肝组织学证实的高剂量甲泼尼龙（MP）诱发的急性肝炎病例，该患者患有多发性硬化症（MS），并报告了向法国里昂药物警戒中心通报的一个病例系列（n = 4）。在所有5例病例中，排除了其他常见的肝炎病因。MP是唯一的致病药物，这一事实支持了与MP脉冲疗法的因果关系。此外，这5例患者中有3例意外地进行了单次或多次MP再激发试验且结果呈阳性。我们的5例患者的RUCAM评分在6分（可能）至10分（极可能）之间。MP诱发的肝损伤可能非常罕见，因为文献中仅报道了不到30例。然而，我们的病例有力地表明，许多病例可能未被识别；我们5例患者中有3例在第二次或第三次急性肝炎发作后才做出最终诊断。总之，我们在此报告的这些病例有力地表明，高剂量MP诱发的肝损伤可能发生在接受MS或自身免疫性疾病治疗的患者中。意外的再激发试验可以证实诊断，并有助于将其与自身免疫性肝炎区分开来。在MP给药前后常规进行肝功能检查将是有益的，因为及时识别这种并发症并早期停药可能预防严重肝坏死损伤的进展。
