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A rare case of methylprednisolone induced hepatitis
Abstracts
JOURNAL OF CLINICAL AND EXPERIMENTAL HEPATOLOGY
21st Annual Conference of Indian National Association for the Study of Liver (INASL), March 22–24, 2013 Hyderabad International Convention Centre, Hyderabad, India
DRUG INDUCED LIVER INJURY (DILI)
Anoop Shivaram Alva, Amit Bhasin, Shanthi Vijayaraghavan Department of Gastroenterology, Sri Ramachandra Medical College, Chennai, India
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. Corresponding author. Anoop Shivaram Alva. E-mail: [email protected]
© 2013, INASL
HEPATO-PROTECTIVE ACTIVITY OF AMANAKKU KARKAM (SIDDHA FORMULATION) IN RATS G. Pramod Reddy,1 R. Kiruthiga,2 Gowthaman,2 P. Satya Rajeswaran,1 R. Ganesan,1 JegaJothiPandian1 1 Siddha Central Research Institute (CCRS), Min. of Health & Family Welfare, Govt of India, Chennai, India, 2School of Chemical & Biotechnology, Sastra University, Tanjavur, India
Background and Aims: The present study was conducted to evaluate the hepatoprotective activity of aqueous extract of Amanakkukarkam (Siddha Formulation) against paracetamol induced liver damage in rats. Methods: The Amanakkukarkam was administered orally to the animals with hepatotoxicity induced by paracetamol. Silymarin was given as reference standard. Results: The formulation was effective in protecting the liver against the injury induced by paracetamol in rats. This was evident from significant reduction in serum enzymes alkaline aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), acid phosphatase (ACP), protein and bilirubin. Conclusion: It was concluded from the result that the AmanakkuKarkam possesses hepatoprotective activity against paracetamol induced hepatotoxicity in rats. Corresponding author. G. Pramod Reddy. E-mail: [email protected]
MOLECULAR RISK ASSESSMENT OF METHYL ISOCYANATE-INDUCED LIVER CARCINOGENESIS Kewal Krishan Maudar, Parduman Kumar Mishra, Puneet Gandhi, Nabila Akhtar Bhopal Memorial Hospital and Research Centre, Bhopal, India
Introduction: The increased incidence of hepatocellular carcinoma (HCC) over the last 50-60 years has been largely attributed to three factors: lifestyle, age and diffusion of environmental carcinogens. Molecular implications of isocyanates, ubiquitous chemicals with wide range of
Journal of Clinical and Experimental Hepatology | March 2013 | Vol. 3 | No. 1S | S37–S40
DILI
A RARE CASE OF METHYLPREDNISOLONE INDUCED HEPATITIS
JOURNAL OF CLINICAL AND EXPERIMENTAL HEPATOLOGY
21st Annual Conference of Indian National Association for the Study of Liver (INASL), March 22–24, 2013 Hyderabad International Convention Centre, Hyderabad, India
DRUG INDUCED LIVER INJURY (DILI)
Anoop Shivaram Alva, Amit Bhasin, Shanthi Vijayaraghavan Department of Gastroenterology, Sri Ramachandra Medical College, Chennai, India
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. Corresponding author. Anoop Shivaram Alva. E-mail: [email protected]
© 2013, INASL
HEPATO-PROTECTIVE ACTIVITY OF AMANAKKU KARKAM (SIDDHA FORMULATION) IN RATS G. Pramod Reddy,1 R. Kiruthiga,2 Gowthaman,2 P. Satya Rajeswaran,1 R. Ganesan,1 JegaJothiPandian1 1 Siddha Central Research Institute (CCRS), Min. of Health & Family Welfare, Govt of India, Chennai, India, 2School of Chemical & Biotechnology, Sastra University, Tanjavur, India
Background and Aims: The present study was conducted to evaluate the hepatoprotective activity of aqueous extract of Amanakkukarkam (Siddha Formulation) against paracetamol induced liver damage in rats. Methods: The Amanakkukarkam was administered orally to the animals with hepatotoxicity induced by paracetamol. Silymarin was given as reference standard. Results: The formulation was effective in protecting the liver against the injury induced by paracetamol in rats. This was evident from significant reduction in serum enzymes alkaline aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), acid phosphatase (ACP), protein and bilirubin. Conclusion: It was concluded from the result that the AmanakkuKarkam possesses hepatoprotective activity against paracetamol induced hepatotoxicity in rats. Corresponding author. G. Pramod Reddy. E-mail: [email protected]
MOLECULAR RISK ASSESSMENT OF METHYL ISOCYANATE-INDUCED LIVER CARCINOGENESIS Kewal Krishan Maudar, Parduman Kumar Mishra, Puneet Gandhi, Nabila Akhtar Bhopal Memorial Hospital and Research Centre, Bhopal, India
Introduction: The increased incidence of hepatocellular carcinoma (HCC) over the last 50-60 years has been largely attributed to three factors: lifestyle, age and diffusion of environmental carcinogens. Molecular implications of isocyanates, ubiquitous chemicals with wide range of
Journal of Clinical and Experimental Hepatology | March 2013 | Vol. 3 | No. 1S | S37–S40
DILI
A RARE CASE OF METHYLPREDNISOLONE INDUCED HEPATITIS