Page 29 - JCTR-10-1

Journal of Clinical and Translational Research 2024; 10(1): 25-32

Journal of Clinical and Translational Research

Journal homepage: http://www.jctres.com/en/home

ORIGINAL ARTICLE

Steroid-responsive intractable pruritus in drug-induced liver injury: a case

series

Aakash Shah, Nitesh Bassi, Shishirendu Parihar, Ishan Mittal, Devesh Prakash Yadav, Vinod Kumar, Vinod Kumar Dixit,
Sunit Kumar Shukla, Anurag Kumar Tiwari*
Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

ARTICLE INFO ABSTRACT

Article history: Background: Drug-induced liver injury (DILI) is commonly caused by modern medications,
Received: August 22, 2023 complementary and alternative medicines (CAMs), and other toxins. DILI is an umbrella term
Accepted: December 19, 2023 encompassing herb-induced liver injury (HILI) caused by herbs and CAMs, in addition to other
Published Online: February 1, 2024 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
Keywords: medications for DILI, except that they are indicated for a few specific conditions.
Drug-induced liver injury Materials and Methods: We report five cases of DILI with pruritus who responded well to steroids
Intractable pruritus used as rescue therapy. DILI in these five cases was caused by CAMs (1), anabolic steroids (2),
Complementary and alternative medicines dapsone (1), and antifungal drug itraconazole (1). All patients presented with jaundice and pruritus,
Herb-induced liver injury 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
*Corresponding author: for causality assessment. R-value was used to describe the pattern of liver injury. All patients underwent
Anurag Kumar Tiwari comprehensive work-up including liver biopsy as part of the procedure to rule out other potential
Department of Gastroenterology, Institute of etiologies. Steroids were used as a last resort, and both clinical and biochemical measurements were
Medical Sciences, Banaras Hindu University, conducted.
Varanasi, Uttar Pradesh, India. Results: The mean age of patients was 28.8 years, and the majority of them were males (80%).
Email: tiwarianuragk@gmail.com 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
© 2024 Author(s). This is an Open-Access were 3.2 weeks and 11.2 weeks, respectively. Extended follow-up was done for a mean period of
article distributed under the terms of the 29.6 weeks from symptom presentation, and none of the patients had recurrence of liver injury after
Creative Commons Attribution-Noncommercial discontinuation of steroids.
License, permitting all non-commercial use,
distribution, and reproduction in any medium, Conclusions: Ssteroids can be used to treat as rescue therapy for severe DILI with intractable pruritus
provided the original work is properly cited. 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.

1. Introduction

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) resulted from herbs, CAMs, and
other medications. DILI is divided into intrinsic (dose-dependent) and idiosyncratic (dose-
independent) injuries [1]. Liver injury may be characterized as cholestatic, hepatocellular,
or mixed injury, according to the results of liver function tests (LFT) and the calculation of
the R-value. DILI may resemble liver diseases, particularly auto-immune hepatitis (AIH),

DOI: https://doi.org/10.36922/jctr.00104