A Rare Case of Methyldopa-Induced Hepatitis

Abstract

Methyldopa is a centrally acting antihypertensive agent commonly used in the management of hypertension. It has been associated with rare but serious hepatotoxic effects. Methyldopa-induced hepatitis is an uncommon but potentially devastating adverse effect that can mimic autoimmune hepatitis (AIH) both clinically and histologically. This report presents the case of a 31-year-old woman with a history of hypertension who developed acute hepatitis following the initiation of methyldopa. The patient presented with fatigue, jaundice, and elevated liver enzymes approximately six weeks after starting therapy. Viral, autoimmune, and metabolic causes of hepatitis were excluded through comprehensive testing. Liver function normalized following the discontinuation of methyldopa, and the patient recovered fully, supporting a diagnosis of drug-induced liver injury (DILI). Causality was assessed using the Roussel Uclaf Causality Assessment Method (RUCAM), yielding a score of 9, indicating a 'highly probable' link between methyldopa and the observed hepatitis.

Keywords: dili; hepatitis; jaundice; liver failure; methyldopa.

Figure 1. Abdominal ultrasound showing hepatomegaly with mild hepatic steatosis (A) and gallbladder (orange arrows) with sludge, without wall thickening (B, C, D)

Figure 2. MRCP axial (A) and coronal (B, C) sequences showing mild hepatomegaly and lymph nodes at the hepatic hilum (orange arrows)

MRCP: magnetic resonance cholangiopancreatography