Severe liver injury induced by mesalazine
10.3760/cma.j.cn114015-20241021-00108
- VernacularTitle:美沙拉秦致重度肝损伤
- Author:
Hanyun GAO
1
;
Junchao ZHANG
;
Zhongjian ZHENG
Author Information
1. 厦门市中医院药学部，厦门 361000
- Publication Type:Journal Article
- Keywords:
Chemical and drug induced liver injury;
Mesalazine;
Colitis, ulcerative;
Severe liver injury
- From:
Adverse Drug Reactions Journal
2025;27(10):637-640
- CountryChina
- Language:Chinese
-
Abstract:
A 38-year-old male patient with ulcerative colitis was treated with mesalazine enteric- coated tablets 2 g twice daily, and developed pruritus, dark urine and jaundice approximately 8 months later. Laboratory tests revealed severe liver function abnormalities, showing alanine aminotransferase (ALT) 1 251 U/L, aspartate aminotransferase (AST) 1 102 U/L, γ-glutamyl transferase (GGT) 615 U/L, alkaline phosphatase (ALP) 715 U/L, total bile acid (TBA) 244.72 μmol/L, total bilirubin (TBil) 456.9 μmol/L, direct bilirubin (DBil) 350.6 μmol/L and indirect bilirubin (IBil) 106.3 μmol/L. Abdominal CT showed no significant abnormalities. Mesalazine was discontinued, and hepatoprotective therapy was initiated with magnesium isoglycyrrhizinate, ademetionine 1,4-butanedisulfonate, acetylcysteine, and ursodeoxycholic acid. Viral hepatitis, Wilson′s disease, and hemochromatosis were ruled out in further investigations and liver biopsy. Severe drug-induced liver injury (DILI) caused by mesalazine was suspected, but autoimmune hepatitis (AIH) could not be entirely excluded. The hepatoprotective treatments were continued, and the patient′s liver function was improved significantly, showing ALT 48 U/L, AST 35 U/L, GGT 144 U/L, ALP 202 U/L, TBA 24.72 μmol/L, TBil 71.8 μmol/L, DBil 62.3 μmol/L and IBil 9.5 μmol/L by day 24 of treatments. Later, he was treated only with ursodeoxycholic acid and bicyclol. The patient′s liver function normalized approximately one and a half months later. However, the patient self-reinitiated mesalazine several days thereafter, and the liver function tests showed ALT 155 U/L and AST 80 U/L after about 2 months of resumed use. Mesalazine was discontinued again, and his liver function returned to normal within 1 week with supportive treatments. AIH was excluded, DILI induced by mesalazine was considered at last.
