Rotondo Eleonora, Graziosi Alessandro, Di Stefano Vincenzo, Mohn Angelika Anna
Department of Paediatrics, "G. d'Annunzio" University, Chieti, Italy.
Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University, Chieti, Italy.
BMJ Case Rep. 2018 Dec 7;11(1):e226687. doi: 10.1136/bcr-2018-226687.
Multiple sclerosis (MS) is a chronic inflammatory disease with demyelination of the central nervous system. High-dosage corticosteroids are the first-line therapy in the acute relapsing of MS. We report a case of severe high-dose methylprednisolone-induced acute hepatitis in a patient with a new diagnosis of MS. A 16-year-old girl was admitted for urticaria, angioedema, nausea and vomiting a month later she had been diagnosed with MS and treated with high-dosage methylprednisolone. Laboratory investigations showed hepatic insufficiency with grossly elevated liver enzymes. A liver biopsy showed focal centrilobular hepatocyte necrosis with interface hepatitis. Methylprednisolone-induced hepatotoxicity can confuse the clinical picture of patients with MS and complicate the differential diagnosis. We believe that each specialist should know it and monitor patients with MS taking high doses of methylprednisolone. As there is no screening model that predicts idiosyncratic hepatotoxicity, we promote screening for potential liver injury following pulse steroid therapy.
多发性硬化症（MS）是一种伴有中枢神经系统脱髓鞘的慢性炎症性疾病。高剂量皮质类固醇是MS急性复发时的一线治疗方法。我们报告了一例新诊断为MS的患者发生严重的高剂量甲泼尼龙诱导的急性肝炎病例。一名16岁女孩在被诊断为MS并接受高剂量甲泼尼龙治疗一个月后，因荨麻疹、血管性水肿、恶心和呕吐入院。实验室检查显示肝功能不全，肝酶显著升高。肝活检显示局灶性小叶中心肝细胞坏死伴界面性肝炎。甲泼尼龙诱导的肝毒性会混淆MS患者的临床症状并使鉴别诊断复杂化。我们认为每位专科医生都应该了解这一点，并对服用高剂量甲泼尼龙的MS患者进行监测。由于没有预测特异质性肝毒性的筛查模型，我们提倡在脉冲类固醇治疗后筛查潜在的肝损伤。
