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Cyclophosphamide-induced liver injury during treatment of interstitial lung disease in juvenile dermatomyositis
  1. Yue Zhang1 and
  2. Christopher Costin2
  1. 1Department of Biochemistry and Molecular Genetics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  2. 2Pediatric Rheumatology, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
  1. Correspondence to Dr Christopher Costin; ccostin{at}


A middle-childhood aged girl with recently diagnosed MDA5+ juvenile dermatomyositis complicated by interstitial lung disease presented with diffuse abdominal pain and scleral icterus following the initiation of cyclophosphamide therapy. A laboratory workup revealed elevated liver enzymes and hyperbilirubinaemia. She was admitted for worsening liver function, and all medications were held with concern for drug-induced liver injury. A workup for infectious and autoimmune causes of transaminitis was negative. A liver biopsy revealed diffuse apoptotic cells without evidence of portal obstruction. A diagnosis of cyclophosphamide-induced liver injury was made. She was initiated on intravenous methylprednisolone with a steroid taper, leading to recovery. Cyclophosphamide was replaced by tofacitinib and abatacept for control of interstitial lung disease, which was well tolerated. Although cyclophosphamide in high doses may cause sinusoidal obstruction syndrome, hepatocellular liver injury is rare. Here to our knowledge, we present the first case report of hepatocellular injury caused by intravenous cyclophosphamide in a paediatric patient with a rheumatic condition.

  • Drugs: musculoskeletal and joint diseases
  • Connective tissue disease
  • Paediatrics
  • Chemotherapy
  • Hepatitis other

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  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: CC and YZ. The following authors gave final approval of the manuscript: CC and YZ.

  • 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.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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