Drug-induced liver injury from high-dose intravenous methylprednisolone: A rare but known adverse effect

In general, the use of steroids is associated with three forms of liver injury that include hepatitis B reactivation, drug-induced liver injury, and steatosis/steatohepatitis. Drug-induced liver injury is a known but rare adverse effect of high-dose steroids. While corticosteroids, including methylprednisolone, are generally considered safe, high doses have been linked to hepatic injury. This form of insult is often idiosyncratic and unpredictable. We present the case of a 60-year-old female who was admitted due to a 6-week history of paresthesia and weakness involving her bilateral hands and feet. Magnetic resonance imaging of the brain, cervical, and thoracic regions revealed several enhancing lesions, highly concerning for multiple sclerosis. One day following high-dose intravenous methylprednisolone, liver enzymes were found to be significantly elevated on her complete metabolic panel. Steroid therapy was discontinued, and liver enzymes returned to normal values within 4 days. Symptoms ultimately resolved following a 7-day course of plasmapheresis. This article brings attention to providers about this rare adverse effect, especially to clinical specialists who often use high-dose steroids. Suggestions regarding monitoring and treatment are also provided.