Menotrophin Induced Autoimmune Hepatitis

Menotrophin is a protein-based hormonal therapy. It is used as a fertility medication that is given as injection either subcutaneously or intramuscularly. Menotrophin has not been previously reported to cause drug-induced liver injury. Drug-induced liver injury (DILI) is commonly seen nowadays with the expansion of the drug industry. It is associated with prescribed medications, over the counter drugs, herbal and dietary supplements. We report the first case of Menotrophin-induced autoimmune hepatitis in a 26-year-old Caucasian woman who was diagnosed with primary infertility due to failure to conceive after five years of marriage. She had received several cycles of Menotrophin, then developed new onset jaundice and fatigue associated with increase in transaminases. She had normal baseline liver function and enzymes prior to receiving treatment with Menotrophin. Evaluation showed no evidence of viral hepatitis, metabolic, alcoholic or vascular causes of liver injury. Autoimmune screening was positive for antinuclear antibody (ANA) with titer of 1 : 640 fine speckled, immunoglobulin G (IgG) level was 1900 mg/dl. Antimitochondrial antibodies (AMA) and antismooth muscle antibodies were negative. Liver biopsy showed features of chronic hepatitis with interface hepatitis and prominence of plasma cells, which best reflects autoimmune hepatitis. Her liver enzymes and bilirubin completely normalized after discontinuation of further Menotrophin therapy and starting treatment with prednisolone and Azathioprine.

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Liver Injury with Features Mimicking Autoimmune Hepatitis following the Use of Black Cohosh

Case Reports in Medicine ◽

10.1155/2009/918156 ◽

2009 ◽

Vol 2009 ◽

pp. 1-8 ◽

Cited By ~ 15

Author(s):

Grace Guzman ◽

Eric R. Kallwitz ◽

Christina Wojewoda ◽

Rohini Chennuri ◽

Jamie Berkes ◽

...

Keyword(s):

Liver Injury ◽

Autoimmune Hepatitis ◽

Plasma Cells ◽

Hepatic Necrosis ◽

Serum Markers ◽

Black Cohosh ◽

Herbal Supplement ◽

Drug Induced ◽

Drug Induced Liver Injury ◽

Immune Mediated

There are a growing number of cases detailing acute hepatic necrosis in patients taking black cohosh (Cimicifuga racemosa), an over-the-counter herbal supplement for management of menopausal symptoms. Our aim is to illustrate two cases of liver injury following the use of black cohosh characterized by histopathological features mimicking autoimmune hepatitis. Both patients reported black cohosh use for at least six months and had no evidence of another cause of liver disease. Their liver biopsies showed a component of centrilobular necrosis consistent with severe drug-induced liver injury. In addition, the biopsies showed characteristics of autoimmune-like liver injury with an interface hepatitis dominated by plasma cells. Although serum markers for autoimmune hepatitis were not particularly elevated, both patients responded to corticosteroids, supporting an immune-mediated component to the liver injury. Liver injury following the use of black cohosh should be included in the list of differential diagnoses for chronic hepatitis with features mimicking autoimmune hepatitis.

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Clinicopathological Study of Autoimmune Hepatitis Cases That Were Difficult to Differentiate from Drug-Induced Liver Injury

Digestive Diseases ◽

10.1159/000480139 ◽

2017 ◽

Vol 35 (6) ◽

pp. 506-514 ◽

Cited By ~ 6

Author(s):

Akemi Tsutsui ◽

Kenichi Harada ◽

Koichi Tsuneyama ◽

Tomonori Senoh ◽

Takuya Nagano ◽

...

Keyword(s):

Liver Injury ◽

Autoimmune Hepatitis ◽

Scale Score ◽

Plasma Cells ◽

Final Diagnosis ◽

Acute Onset ◽

Pathological Findings ◽

Drug Induced ◽

Drug Induced Liver Injury ◽

Scale Scores

Aim: Acute-onset autoimmune hepatitis (AIH) histopathologically presents with features of acute hepatitis and lacks a specific diagnostic method. Also, AIH is often difficult to differentiate from drug-induced liver injury (DILI). We aimed to investigate the final clinical diagnosis of these cases, and compare the clinical, biochemical, and histological characteristics of AIH vs. DILI. Methods: We examined the Digestive Disease Week Japan 2004 (DDW-J) scale scores, AIH scores, clinical data, and pathological findings in 20 patients in whom it was difficult to differentiate autoimmune liver disease from DILI. Results: In cases with a DDW-J scale score of ≥5, there was a good correlation between the final diagnosis and DDW-J scale assessments, but in cases with a DDW-J scale score of ≦4 they did not correlate well. The scores for pathological findings, such as cobblestone hepatocellular change (p = 0.015), interface hepatitis (p = 0.012), and prominent plasma cells in portal areas (p = 0.011), were higher in the AIH group than in the DILI group. Conclusion: This study showed that DDW-J scale was useful for differentiating AIH from DILI in cases with a DDW-J scale score of ≧5. The histologic features of AIH were characterized by cobblestone hepatocellular change, interface hepatitis, and plasma cell infiltration of the portal region.

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Drug-Induced Autoimmune Hepatitis following Treatment with Zoledronic Acid

Case Reports in Gastroenterology ◽

10.1159/000479314 ◽

2017 ◽

Vol 11 (2) ◽

pp. 440-445 ◽

Cited By ~ 4

Author(s):

Jenny Sarah Schneider ◽

Matteo Montani ◽

Felix Stickel

Keyword(s):

Liver Disease ◽

Zoledronic Acid ◽

Side Effects ◽

Liver Injury ◽

Drug Reactions ◽

Drug Induced ◽

Drug Induced Liver Injury ◽

First Case ◽

Alternative Drugs

Adverse drug reactions are among the most frequent side effects of synthetic and complementary alternative drugs and represent the premier causes of license revocations and acute liver failure. Drug-induced liver injury can resemble literally any other genuine liver disease and usually responds well to drug dechallenge. However, in some cases autoimmune-like hepatitis can evolve, requiring short- and sometimes long-term immunosuppression. Here, we present the hitherto first case of autoimmune-like hepatitis following treatment with zoledronic acid.

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Hepatotoxicity of immune checkpoint inhibitors: a histology study of seven cases in comparison with autoimmune hepatitis and idiosyncratic drug-induced liver injury

Modern Pathology ◽

10.1038/s41379-018-0013-y ◽

2018 ◽

Vol 31 (6) ◽

pp. 965-973 ◽

Cited By ~ 84

Author(s):

Yoh Zen ◽

Matthew M. Yeh

Keyword(s):

Liver Injury ◽

Autoimmune Hepatitis ◽

Immune Checkpoint ◽

Immune Checkpoint Inhibitors ◽

Checkpoint Inhibitors ◽

Drug Induced ◽

Drug Induced Liver Injury

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Severe Drug-Induced Liver Injury from Combination Encorafenib/Binimetinib

Case Reports in Oncological Medicine ◽

10.1155/2019/3051945 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Nicholas Gravbrot ◽

Srinath Sundararajan

Keyword(s):

Liver Injury ◽

Liver Function ◽

Combination Therapy ◽

Hepatic Injury ◽

Mek Inhibitor ◽

New Combination ◽

Normal Range ◽

Drug Induced ◽

Drug Induced Liver Injury ◽

First Case

Encorafenib/binimetinib is a new combination BRAF/MEK inhibitor used in the treatment of advanced or metastatic BRAFV600-mutant melanoma. Though generally tolerated well, mild to moderate aminotransferase elevations are common. However, significant liver injury has not been demonstrated in the literature. Here, we report the first case of severe hepatic injury associated with encorafenib/binimetinib in a 58-year-old gentleman requiring admission and extensive workup. He was successfully treated by withdrawing the combination therapy, and liver function returned to normal range.

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