Abstract
Glatiramer acetate (copolymer 1) is an immunomodulator-approved for treatment of relapsing-remitting MS (RRMS) with no known hepatotoxic effects, unlike the interferon beta preparations. We report a case of severe acute hepatitis after commencing treatment for multiple sclerosis with glatiramer acetate. A 31-year-old female with multiple sclerosis presented with anorexia, lethargy, and jaundice, five weeks after commencing glatiramer acetate. She had never received beta-interferon treatment. Investigations revealed a bilirubin of 1.2 mg/dl AST of 879 u/L, ALT of 1215 u/L. Her liver function tests were normal before commencing glatiramer acetate. A liver biopsy performed approximately six weeks after commencement of glatiramer acetate showed marked centrilobular congestion and hemorrhage with hemosiderin laden macrophages. Mild periportal chronic inflammatory infiltrate with scattered eosinophils. The features were not suggestive of autoimmune hepatitis, but were consistent with drug toxicity. The liver tests returned to normal within a month of cessation of glatiramer acetate. Adverse reactions should be considered in patients with liver injury and on glatiramer therapy. Mainstay therapy would be stopping the medication. Consideration should be given to monitoring liver function tests during long-term glatiramer therapy. Diagnosis rests on the identification of temporal association between drug and liver injury, and exclusion of other conditions.FigureFigureFigure
Published Version
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