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Methylprednisolone was stopped and aminotransferase levels normalized within four days. After resolution of symptoms following plasmapheresis, the authors highlight monitoring and treatment considerations for clinicians frequently using high-dose 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--- | --- |\n\nSubmit a Manuscript: [https://www.f6publishing.com](https://www.f6publishing.com) World J Gastrointest Pathophysiol 2025 December 22; 16(4): 111306  \nDOI: 10.4291/wjgp.v16.i4.111306 ISSN 2150-5330 (online)  \nLETTER TO THE EDITOR  \nDrug-induced liver injury from high-dose intravenous methylprednisolone: A rare but known adverse effect  \nKevan English  \nSpecialty type: Gastroenterology and hepatology  \nProvenance and peer review:  \nInvited article; Externally peer reviewed.  \nPeer-review model: Single blind  \nPeer-review report’s classification Scientific Quality: Grade B, Grade B, Grade C, Grade C, Grade C, Grade D  \nNovelty: Grade B, Grade B, Grade C, Grade C, Grade C, Grade D Creativity or Innovation: Grade B, Grade C, Grade C, Grade C, Grade C, Grade D  \nScientific Significance: Grade B, Grade B, Grade C, Grade C, Grade C, Grade C  \nP-Reviewer: Devulapalli CS, MD, PhD, Consultant, Senior Researcher, Senior Scientist, Norway; Kumar R, MD, Professor, India; Owu DU, PhD, Professor, Uganda  \nReceived: June 27, 2025  \nRevised: July 30, 2025  \nAccepted: September 17, 2025  \nPublished online: December 22, 2025  \nProcessing time: 178 Days and 11.5 Hours  \nKevan English, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198, United States  \nCorresponding author: Kevan English, MD, Department of Internal Medicine, University of Nebraska Medical Center, 42nd and Emile, Omaha, NE 68198, United States.  \n[keenglish@unmc.edu](keenglish@unmc.edu)  \nAbstract  \nIn 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 highdose 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.  \nKey Words: Methylprednisolone; Drug-induced liver injury; Corticosteroids; Hepatotoxicity; Transaminitis; Glucocorticoids; Multiple sclerosis; Inflammation  \n©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.  \n WJGP  [https://www.wjgnet.com](https://www.wjgnet.com) 1 December 22, 2025  Volume 16  Issue 4   \nEnglish K. DILI from high-dose intravenous Methyl-PNL  \nCore 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 MethylPNL. 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 dru","cbCaipVaNWxOeZad","https://ap.wps.com/l/cbCaipVaNWxOeZad","pdf",395285,"English","# Letter to the Editor\n## Drug-induced liver injury from high-dose intravenous methylprednisolone\n## Abstract and key findings\n## Core Tip and commentary","[{\"question\":\"What liver injuries are generally associated with steroid use in the article?\",\"answer\":\"Steroids are associated with three forms of liver injury mentioned: hepatitis B reactivation, drug-induced liver injury, and steatosis/steatohepatitis.\"},{\"question\":\"What happened to liver enzymes after high-dose intravenous methylprednisolone?\",\"answer\":\"One day after treatment started, the patient’s liver enzymes were significantly elevated compared with prior values, and transaminases returned to normal within about four days after discontinuation.\"},{\"question\":\"How did the patient’s symptoms and treatment course progress?\",\"answer\":\"Symptoms ultimately resolved after a seven-day course of plasmapheresis, following discontinuation of steroid therapy.\"}]","Drug-induced liver injury from high-dose intravenous methylprednisolone: A rare but known adverse effect | PDF",1790566585,15]