Fibrosing cholestatic hepatitis after methotrexate and prednisone therapy for rheumatoid arthritis

Exp Clin Transplant. 2014 Mar:12 Suppl 1:95-7.

Abstract

Objectives: Fibrosing cholestatic hepatitis is an aggressive and usually fatal form of viral hepatitis in immunosuppressed patients. We assessed the hepatotoxicity of methotrexate and prednisolone combination therapy in the background of hepatitis B virus infection.

Materials and methods: We report the clinical course of a 55-year-old woman who underwent a deceased-donor liver transplant for fulminant liver failure.

Results: The patient's medical history was significant for hepatitis B virus infection and rheumatoid arthritis. Methotrexate and prednisolone combination therapy were started 5 months earlier. The patient was hospitalized because of an elevation in her liver enzymes and total bilirubin. Deterioration of liver functions and encephalopathy were developed 5 weeks after hospital admission. A deceased-donor liver transplant was performed, and pathological examination of recipient liver revealed fibrosing cholestatic hepatitis. The patient was reoperated on for bile leak and discharged 40 days after the deceased-donor liver transplant.

Conclusions: The natural course of the current case was similar to previously reported cases with fibrosing cholestatic hepatitis. Clinicians should consider the potential hepatotoxicity of methotrexate and steroid therapy in hepatitis B virus infected patients.

Publication types

  • Case Reports

MeSH terms

  • Antirheumatic Agents / adverse effects*
  • Arthritis, Rheumatoid / diagnosis
  • Arthritis, Rheumatoid / drug therapy*
  • Biopsy
  • Chemical and Drug Induced Liver Injury / diagnosis
  • Chemical and Drug Induced Liver Injury / etiology*
  • Chemical and Drug Induced Liver Injury / surgery
  • Cholestasis, Intrahepatic / chemically induced*
  • Cholestasis, Intrahepatic / diagnosis
  • Cholestasis, Intrahepatic / surgery
  • Drug Therapy, Combination
  • Female
  • Hepatitis B / complications*
  • Hepatitis B / diagnosis
  • Humans
  • Liver Cirrhosis / chemically induced*
  • Liver Cirrhosis / diagnosis
  • Liver Cirrhosis / surgery
  • Liver Failure, Acute / diagnosis
  • Liver Failure, Acute / etiology
  • Liver Failure, Acute / surgery
  • Liver Transplantation
  • Methotrexate / adverse effects*
  • Middle Aged
  • Prednisone / adverse effects*
  • Treatment Outcome

Substances

  • Antirheumatic Agents
  • Prednisone
  • Methotrexate