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Mycophenolate mofetil-induced liver injury in a patient with aquaporin-4 antibody positive transverse myelitis
  1. Arun Iyer,
  2. Madeleine Frank,
  3. Susan Davies and
  4. William T Gelson
  1. Hepatology, Addenbrooke's Hospital, Cambridge, UK
  1. Correspondence to Dr Madeleine Frank; madeleinefrank{at}


We present a case of a 49-year-old woman diagnosed with aquaporin-4 antibody-positive transverse myelitis, who developed a significant transaminitis 2 months after commencing mycophenolate mofetil (MMF) as a steroid-sparing agent. No other risk factors were identified, a blood liver panel was negative and liver biopsy showed features compatible with drug-induced liver injury (DILI). MMF was stopped with a corresponding normalisation of serum alanine aminotransferase over the next 2 months. This case highlights MMF as a rare cause of DILI and provides justification for monitoring of liver biochemistry on therapy.

  • drugs: gastrointestinal system
  • unwanted effects / adverse reactions

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  • Contributors MF and AI planned and wrote the case report. SD provided the images included in the report. WG treated the patient and edited the case report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.