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Philips C, Paramaguru R, Mahadevan P, et al. Metoprolol-induced Severe Liver Injury and Successful Management with Therapeutic Plasma Exchange. Cureus. 2017;9(5):e1209doi: 10.7759/cureus.1209.
Philips, C., Paramaguru, R., Mahadevan, P., Ravindranath, J., & Augustine, P. (2017). Metoprolol-induced Severe Liver Injury and Successful Management with Therapeutic Plasma Exchange. Cureus, 9(5), e1209. https://doi.org/10.7759/cureus.1209
Philips, Cyriac, et al. "Metoprolol-induced Severe Liver Injury and Successful Management with Therapeutic Plasma Exchange." Cureus vol. 9,5 (2017): e1209. doi: https://doi.org/10.7759/cureus.1209
Philips C, Paramaguru R, Mahadevan P, Ravindranath J, Augustine P. Metoprolol-induced Severe Liver Injury and Successful Management with Therapeutic Plasma Exchange. Cureus. 2017 May 02;9(5):e1209. doi: 10.7759/cureus.1209. PMID: 28589058; PMCID: PMC5453740.
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Cureus. 2017 May 02;9(5):e1209. doi: 10.7759/cureus.1209.

Metoprolol-induced Severe Liver Injury and Successful Management with Therapeutic Plasma Exchange.

Cureus

Cyriac Philips, Rajaguru Paramaguru, Pushpa Mahadevan, Jayasurya Ravindranath, Philip Augustine

Affiliations

  1. Hepatology and Liver Transplant Medicine, PVS Memorial Hospital.
  2. Pathology, PVS Memorial Hospital.
  3. Pathology, VPS Lakeshore Hospital, Kochi.
  4. Nephrology, PVS Memorial Hospital.
  5. Gastroenterology, PVS Institute of Digestive Diseases, PVS Memorial Hospital.

PMID: 28589058 PMCID: PMC5453740 DOI: 10.7759/cureus.1209

Abstract

Liver injury caused by metoprolol is very rare with current reports limited to an isolated elevation in transaminases. We report the first case of severe icteric liver injury leading to hepatic encephalopathy secondary to metoprolol use in a patient diagnosed with coronary heart disease. We also describe the histopathology of metoprolol-related liver injury, discuss mechanisms of injury with new insights on the immunological phenomenon, and shed light on the successful utility of early plasmapheresis as a salvage therapy in metoprolol-induced severe liver damage.

Keywords: beta blockers; dili; hepatocellular injury; idiosyncratic reaction; liver injury; plasma exchange

Conflict of interest statement

The authors have declared that no competing interests exist.

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