English K. Drug-induced liver injury from high-dose intravenous methylprednisolone: A rare but known adverse effect. World J Gastrointest Pathophysiol 2025; 16(4): 111306 [PMID: 41479865 DOI: 10.4291/wjgp.v16.i4.111306]
Corresponding Author of This Article
Kevan English, MD, Department of Internal Medicine, University of Nebraska Medical Center, 42nd and Emile, Omaha, NE 68198, United States. keenglish@unmc.edu
Research Domain of This Article
Gastroenterology & Hepatology
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Letter to the Editor
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 22, 2025 (publication date) through Jan 18, 2026
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Publication Name
World Journal of Gastrointestinal Pathophysiology
ISSN
2150-5330
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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English K. Drug-induced liver injury from high-dose intravenous methylprednisolone: A rare but known adverse effect. World J Gastrointest Pathophysiol 2025; 16(4): 111306 [PMID: 41479865 DOI: 10.4291/wjgp.v16.i4.111306]
World J Gastrointest Pathophysiol. Dec 22, 2025; 16(4): 111306 Published online Dec 22, 2025. doi: 10.4291/wjgp.v16.i4.111306
Drug-induced liver injury from high-dose intravenous methylprednisolone: A rare but known adverse effect
Kevan English
Kevan English, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, United States
Author contributions: English K wrote the original draft, contributed to conceptualization, writing, reviewing, and editing. The author read and approved the final version of the manuscript.
Conflict-of-interest statement: The author reports no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kevan English, MD, Department of Internal Medicine, University of Nebraska Medical Center, 42nd and Emile, Omaha, NE 68198, United States. keenglish@unmc.edu
Received: June 27, 2025 Revised: July 30, 2025 Accepted: September 17, 2025 Published online: December 22, 2025 Processing time: 178 Days and 12 Hours
Abstract
In general, the use of steroids is associated with three forms of liver injury that include hepatitis B reactivation, drug-induced liver injury, and steatosis/steatohepatitis. Drug-induced liver injury is a known but rare adverse effect of high-dose steroids. While corticosteroids, including methylprednisolone, are generally considered safe, high doses have been linked to hepatic injury. This form of insult is often idiosyncratic and unpredictable. We present the case of a 60-year-old female who was admitted due to a 6-week history of paresthesia and weakness involving her bilateral hands and feet. Magnetic resonance imaging of the brain, cervical, and thoracic regions revealed several enhancing lesions, highly concerning for multiple sclerosis. One day following high-dose intravenous methylprednisolone, liver enzymes were found to be significantly elevated on her complete metabolic panel. Steroid therapy was discontinued, and liver enzymes returned to normal values within 4 days. Symptoms ultimately resolved following a 7-day course of plasmapheresis. This article brings attention to providers about this rare adverse effect, especially to clinical specialists who often use high-dose steroids. Suggestions regarding monitoring and treatment are also provided.
Core Tip: Corticosteroids are widely used in the treatment of various diseases. In general, these medications are considered safe. However, several recent cases have reported severe liver injury with high-dose methylprednisolone (Methyl-PNL). This article reports a case of asymptomatic hepatitis from high-dose Methyl-PNL that resolved with medication discontinuation. This known adverse effect should not preclude providers from treating various clinical conditions with high-dose Methyl-PNL. However, it should not be surprising if acute hepatitis or severe liver injury occurs as an adverse reaction, especially with high doses. We call for more providers to be aware of this idiosyncratic and rare drug side effect.
