Abstract
Background: Drug-induced liver injury (DILI) is commonly caused by modern medications,
complementary and alternative medicines (CAMs), and other toxins. DILI is an umbrella term
encompassing herb-induced liver injury (HILI) caused by herbs and CAMs, in addition to other
medications. Apart from the cessation of the culprit drug and the supportive management, there are
no definite treatment options for DILI. Although being used in DILI, steroids are not the standard
medications for DILI, except that they are indicated for a few specific conditions.
Materials and Methods: We report five cases of DILI with pruritus who responded well to steroids
used as rescue therapy. DILI in these five cases was caused by CAMs (1), anabolic steroids (2),
dapsone (1), and antifungal drug itraconazole (1). All patients presented with jaundice and pruritus,
and their conditions did not improve following the discontinuation of offending agents and the
implementation of supportive care. We used the Roussel UCLAF Causality Assessment Method 2016
for causality assessment. R-value was used to describe the pattern of liver injury. All patients underwent
comprehensive work-up including liver biopsy as part of the procedure to rule out other potential
etiologies. Steroids were used as a last resort, and both clinical and biochemical measurements were
conducted.
Results: The mean age of patients was 28.8 years, and the majority of them were males (80%).
The median duration from symptom onset to presentation at our hospital was 4 weeks. The mean
durations for pruritus improvement and complete biochemical improvement after steroid treatment
were 3.2 weeks and 11.2 weeks, respectively. Extended follow-up was done for a mean period of
29.6 weeks from symptom presentation, and none of the patients had recurrence of liver injury after
discontinuation of steroids.
Conclusions: Ssteroids can be used to treat as rescue therapy for severe DILI with intractable pruritus
in patients with worsening liver function.
Relevance for Patients: DILI in selected cases can be therapeutically managed using steroids, which,
however, should not be indicated as a first-line treatment.
DOI: https://doi.org/10.36922/jctr.00104
Author affiliation
Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
*Corresponding author:
Anurag Kumar Tiwari
Department of Gastroenterology, Institute of
Medical Sciences, Banaras Hindu University,
Varanasi, Uttar Pradesh, India.
Email: tiwarianuragk@gmail.com
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