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A Rare Case of Methyldopa-Induced Hepatitis

Summary

A 31-year-old woman developed severe liver inflammation (hepatitis) six weeks after starting methyldopa, a common blood pressure medication. After stopping the drug, her liver function returned to normal without needing steroids or other intensive treatments. This case reminds doctors that even commonly used, safe medications can rarely cause serious liver problems and should be considered when patients develop unexplained liver inflammation.

Background

Methyldopa is a centrally acting antihypertensive agent commonly used for hypertension management, particularly in pregnant women. While generally well-tolerated, methyldopa has been associated with rare but serious hepatotoxic effects that can mimic autoimmune hepatitis both clinically and histologically.

Objective

This case report describes a 31-year-old woman who developed acute hepatitis following methyldopa initiation for hypertension. The objective was to establish the diagnosis of drug-induced liver injury and exclude alternative etiologies through comprehensive clinical and biochemical evaluation.

Results

All viral, autoimmune, and metabolic causes were excluded. Imaging revealed hepatomegaly with mild steatosis and reactive lymphadenopathy. RUCAM score of 9 indicated a highly probable causal relationship. Liver function normalized following methyldopa discontinuation, and the patient achieved full recovery within six weeks without corticosteroid therapy.

Conclusion

Methyldopa-induced hepatitis, though rare, should be considered in the differential diagnosis of acute hepatitis in patients recently started on this medication. Early recognition and prompt drug discontinuation are vital to prevent progression to severe liver injury and typically result in complete recovery without immunosuppressive therapy.
  • Published in:Cureus,
  • Study Type:Case Report,
  • Source: PMID: 40575235
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