5-Aminosalicylic Acid-Induced Liver Injury in a Patient with Ulcerative Colitis: A Case Report
Introduction: Drug-induced liver injury (DILI) associated with 5-aminosalicylic acid (5-ASA) is a rare but potentially life-threatening adverse event. Case Presentation: We report the case of a 58-year-old woman with ulcerative colitis who developed DILI after initiating maintenance therapy with the...
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Karger Publishers
2024-01-01
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| Series: | Case Reports in Gastroenterology |
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| author | Asuka Watanabe Tsutomu Nishida Naoto Osugi Takao Kitanaka Yutaro Minoura Satoru Okabe Naohiro Sakamoto Yoshifumi Fujii Aya Sugimoto Dai Nakamatsu Kengo Matsumoto Masashi Yamamoto Shiro Adachi Koji Fukui |
| author_facet | Asuka Watanabe Tsutomu Nishida Naoto Osugi Takao Kitanaka Yutaro Minoura Satoru Okabe Naohiro Sakamoto Yoshifumi Fujii Aya Sugimoto Dai Nakamatsu Kengo Matsumoto Masashi Yamamoto Shiro Adachi Koji Fukui |
| author_sort | Asuka Watanabe |
| collection | DOAJ |
| description | Introduction: Drug-induced liver injury (DILI) associated with 5-aminosalicylic acid (5-ASA) is a rare but potentially life-threatening adverse event. Case Presentation: We report the case of a 58-year-old woman with ulcerative colitis who developed DILI after initiating maintenance therapy with the multimatrix system 5-ASA. The patient presented with grade 4 liver enzyme elevation on day 98 after initiating 5-ASA and was admitted to the hospital. Blood tests revealed the mixed liver injury, and imaging studies showed no abnormalities except for mild lymph node enlargement. Liver biopsy revealed acute lobular hepatitis with interfacial activity. The patient’s score on the International Autoimmune Hepatitis Group 1999 revised scoring system was a total score of 10, causing a suspicion for the diagnosis of autoimmune hepatitis. The DDW-J 2004 scale calculated a total score of six, indicating a high probability of DILI. We suspected DILI due to 5-ASA, and the 5-ASA formulations were discontinued. The patient was treated with ursodeoxycholic acid and neominophagen C, and her liver function gradually improved without steroid treatment. Finally, we definitively diagnosed DILI based on the pathological findings and clinical course after discontinuation of 5-ASA. Conclusion: This case highlights the importance of monitoring liver function in patients receiving 5-ASA therapy. |
| first_indexed | 2024-03-07T19:39:28Z |
| format | Article |
| id | doaj.art-866bd9910828445a93e4eed649a329ae |
| institution | Directory Open Access Journal |
| issn | 1662-0631 |
| language | English |
| last_indexed | 2024-03-07T19:39:28Z |
| publishDate | 2024-01-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | Case Reports in Gastroenterology |
| spelling | doaj.art-866bd9910828445a93e4eed649a329ae2024-02-29T07:06:18ZengKarger PublishersCase Reports in Gastroenterology1662-06312024-01-01181394810.1159/0005360975360975-Aminosalicylic Acid-Induced Liver Injury in a Patient with Ulcerative Colitis: A Case ReportAsuka Watanabe0Tsutomu Nishida1Naoto Osugi2Takao Kitanaka3Yutaro Minoura4Satoru Okabe5Naohiro Sakamoto6Yoshifumi Fujii7Aya Sugimoto8Dai Nakamatsu9Kengo Matsumoto10Masashi Yamamoto11Shiro Adachi12Koji Fukui13Department of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, JapanDepartment of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, JapanDepartment of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, JapanDepartment of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, JapanDepartment of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, JapanDepartment of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, JapanDepartment of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, JapanDepartment of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, JapanDepartment of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, JapanDepartment of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, JapanDepartment of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, JapanDepartment of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, JapanDepartment of Pathology, Toyonaka Municipal Hospital, Toyonaka, JapanDepartment of Gastroenterology, Toyonaka Municipal Hospital, Toyonaka, JapanIntroduction: Drug-induced liver injury (DILI) associated with 5-aminosalicylic acid (5-ASA) is a rare but potentially life-threatening adverse event. Case Presentation: We report the case of a 58-year-old woman with ulcerative colitis who developed DILI after initiating maintenance therapy with the multimatrix system 5-ASA. The patient presented with grade 4 liver enzyme elevation on day 98 after initiating 5-ASA and was admitted to the hospital. Blood tests revealed the mixed liver injury, and imaging studies showed no abnormalities except for mild lymph node enlargement. Liver biopsy revealed acute lobular hepatitis with interfacial activity. The patient’s score on the International Autoimmune Hepatitis Group 1999 revised scoring system was a total score of 10, causing a suspicion for the diagnosis of autoimmune hepatitis. The DDW-J 2004 scale calculated a total score of six, indicating a high probability of DILI. We suspected DILI due to 5-ASA, and the 5-ASA formulations were discontinued. The patient was treated with ursodeoxycholic acid and neominophagen C, and her liver function gradually improved without steroid treatment. Finally, we definitively diagnosed DILI based on the pathological findings and clinical course after discontinuation of 5-ASA. Conclusion: This case highlights the importance of monitoring liver function in patients receiving 5-ASA therapy.https://beta.karger.com/Article/FullText/5360975-aminosalicylic aciddrug-induced liver injuryulcerative colitisliver biopsyinterface hepatitis |
| spellingShingle | Asuka Watanabe Tsutomu Nishida Naoto Osugi Takao Kitanaka Yutaro Minoura Satoru Okabe Naohiro Sakamoto Yoshifumi Fujii Aya Sugimoto Dai Nakamatsu Kengo Matsumoto Masashi Yamamoto Shiro Adachi Koji Fukui 5-Aminosalicylic Acid-Induced Liver Injury in a Patient with Ulcerative Colitis: A Case Report Case Reports in Gastroenterology 5-aminosalicylic acid drug-induced liver injury ulcerative colitis liver biopsy interface hepatitis |
| title | 5-Aminosalicylic Acid-Induced Liver Injury in a Patient with Ulcerative Colitis: A Case Report |
| title_full | 5-Aminosalicylic Acid-Induced Liver Injury in a Patient with Ulcerative Colitis: A Case Report |
| title_fullStr | 5-Aminosalicylic Acid-Induced Liver Injury in a Patient with Ulcerative Colitis: A Case Report |
| title_full_unstemmed | 5-Aminosalicylic Acid-Induced Liver Injury in a Patient with Ulcerative Colitis: A Case Report |
| title_short | 5-Aminosalicylic Acid-Induced Liver Injury in a Patient with Ulcerative Colitis: A Case Report |
| title_sort | 5 aminosalicylic acid induced liver injury in a patient with ulcerative colitis a case report |
| topic | 5-aminosalicylic acid drug-induced liver injury ulcerative colitis liver biopsy interface hepatitis |
| url | https://beta.karger.com/Article/FullText/536097 |
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