open access

Vol 49, No 6 (2015)
Case reports
Submitted: 2015-03-28
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Acute liver failure and liver transplantation in a patient with multiple sclerosis treated with interferon beta

Dorota Kozielewicz, Małgorzata Pawłowska
DOI: 10.1016/j.pjnns.2015.08.006
·
Neurol Neurochir Pol 2015;49(6):451-455.

open access

Vol 49, No 6 (2015)
Case reports
Submitted: 2015-03-28

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.

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.

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Keywords

Acute liver failure, Drug induced liver injury, Interferon β, Multiple sclerosis

About this article
Title

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

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 49, No 6 (2015)

Pages

451-455

DOI

10.1016/j.pjnns.2015.08.006

Bibliographic record

Neurol Neurochir Pol 2015;49(6):451-455.

Keywords

Acute liver failure
Drug induced liver injury
Interferon β
Multiple sclerosis

Authors

Dorota Kozielewicz
Małgorzata Pawłowska

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