Toxicidad hepática recurrente secundaria a metilprednisolona intravenosa

Adverse drug reactions (hepatotoxicity) are a frequent cause of acute liver injury with a wide clinical and histological spectrum. An early recognition of drug-related liver disease has been considered essential in clinical practice due to potential risks. In most cases exposure discontinuation improves the clinical picture. Steroids are used in a variety of clinical settings. However, in travenous steroids have rarely been associated with hepatotoxici ty. We report the case of a middle-aged woman with multiple scle rosis who received a bolus of methylprednisolone on three occasions for the management of relapsing disease, with the de velopment of repeated episodes of elevated liver enzymes after corticoid administration. In the third episode a liver biopsy was performed, which showed acute hepatitis with bridging necrosis; such histological picture has not been described before in patients treated with intravenous steroids.