Acute liver failure and liver transplantation in a patient with multiple sclerosis treated with interferon beta

Abstract

In the treatment of multiple sclerosis (MS), interferon beta (IFNβ) applies. It rarely can lead to acute liver failure (ALF).

A 42-year-old female with MS was admitted to the Department because of jaundice, general weakness, drowsiness and nausea. Four weeks earlier, she had started therapy with IFNβ-1a. Liver tests made prior to initiation of IFNβ-1a were normal but on admission to the Department exceed several times the upper limit. ALF was recognized and IFNβ-1a was immediately stopped. In the fourth day of hospitalization, symptoms of hepatic encephalopathy have progressed. The patient was transferred to the Department of Transplantation, where hepatic coma developed and three days later the orthotopic liver transplantation was performed. In histopathological picture of the removed liver extensive necrosis and fibrosis dominated. Immunosuppressive therapy consisted of tacrolimus, mycophenolate mofetil and tapering prednisone. Within five years after surgery, there was no recurrence of symptoms of MS and the transplanted organ is functioning properly.

ALF is a rare complication of IFNβ therapy but it can occur. The appearance of symptoms suggestive of liver injury should prompt extension of diagnosis and, if necessary, discontinuation of therapy.