Autoimmune hepatitis during intravenous glucocorticoid pulse therapy for Graves' ophthalmopathy treated successfully with glucocorticoids themselves

We report a case of acute hepatitis of autoimmune origin which occurred in a 43-yr-old woman during iv glucocorticoid (GC) pulse therapy for Graves' ophthalmopathy (GO). Prior to therapy, liver function tests were normal with no previous history of liver disorders or conditions predisposing to...

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Bibliographic Details
Published in:	Journal of endocrinological investigation Vol. 28; no. 3; pp. 280 - 284
Main Authors:	Marinò, M, Morabito, E, Altea, M A, Ambrogini, E, Oliveri, F, Brunetto, M R, Pollina, L E, Campani, D, Vitti, P, Bartalena, L, Pincheral, A, Marcocci, C
Format:	Journal Article
Language:	English
Published:	Italy 01-03-2005
Subjects:	Adult Anti-Inflammatory Agents - adverse effects Anti-Inflammatory Agents - therapeutic use Body Mass Index Female Glucocorticoids - adverse effects Glucocorticoids - therapeutic use Graves Disease - complications Graves Disease - drug therapy Graves Disease - radiotherapy Hepatitis, Autoimmune - etiology Humans Liver - enzymology Liver - pathology Liver Function Tests Lymphocytes - physiology Methylprednisolone - adverse effects Methylprednisolone - therapeutic use Prednisone - therapeutic use
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Summary:	We report a case of acute hepatitis of autoimmune origin which occurred in a 43-yr-old woman during iv glucocorticoid (GC) pulse therapy for Graves' ophthalmopathy (GO). Prior to therapy, liver function tests were normal with no previous history of liver disorders or conditions predisposing to GC-associated liver damage. After the administration of a 4.7-g cumulative dose of methylprednisolone acetate, there was a marked increase of liver enzymes, prompting immediate discontinuation of iv GC. Nevertheless, liver enzymes increased further, reaching a peak 45 days later, with values 30- to 50-fold greater than those prior to therapy, associated with evidence of impaired liver function. Liver biopsy showed a marked lymphocytic infiltration, likely indicating an autoimmune hepatitis. Based on the assumption that following GC-induced immune suppression, autoimmune hepatitis might have been precipitated by sudden re-activation of the immune system during interpulse periods, we treated the patient with im and then oral GC, in order to re-induce immune suppression. Within three days from re-institution of GC therapy, there was a marked reduction of liver enzymes and amelioration of liver function. Complete normalization was achieved two months later, while the patient was still receiving a low maintenance dose of oral prednisone.
ISSN:	0391-4097 1720-8386
DOI:	10.1007/BF03345386