• Cristiane Munaretto Ferreira, Erica Freire de Vasconcelos-Pereira, Vanessa Marcon de Oliveira, Pedro Rippel Salgado, João Américo Domingos, MonrealMaria Tereza Ferreira DuenhasMTFDPharmacy School Profª Ana Maria Cervantes Baraza, Faculty Pharmaceutical Sciences, Food and Nutrition, Federal University of Mato Grosso do Sul, Campo Grande - MS, Brazil., Elvira Maria Guerra-Shinohara, and Vanessa Terezinha Gubert.
• Pharmacy Post-Graduation Program, Faculty Pharmaceutical Sciences, Food and Nutrition, Federal University of Mato Grosso do Sul, Campo Grande - MS, Brazil.
• Medicine (Baltimore). 2021 Dec 23; 100 (51): e28246e28246.

RationaleTeriflunomide is an inhibitor of pyrimidine synthesis available as a first-line treatment for relapsing-remitting multiple sclerosis. Drug-induced liver damage is a relevant problem in clinical practice, representing a frequent cause of treatment discontinuation. This case report describes the occurrence of liver injury, with a 33.7-fold increase in the upper limit of normality of the liver enzyme alanine aminotransferase during treatment with teriflunomide 14 mg.Patient ConcernA 44-year-old woman receiving teriflunomide 14 mg for the treatment of multiple sclerosis presented symptoms suggestive of liver dysfunction 54 days after starting treatment. The patient had no history of using disease-modifying therapy, neither previous liver disease nor other comorbidities.DiagnosticsThe suggested diagnosis was drug-induced liver injury, classified as hepatocellular. Other possible hepatic and autoimmune etiologies were ruled out.InterventionsReplacement of teriflunomide treatment with glatiramer acetate and follow-up of the disease.OutcomesSigns and symptoms regressed after treatment with teriflunomide 14 mg was discontinued, with normalization of liver enzyme activity in ∼5 months. The causality assessment of the adverse drug reaction was determined by the Naranjo scaling system, resulting in probable, with a final score of 7.ConclusionsTeriflunomide-induced liver injury in patients with multiple sclerosis is a serious adverse reaction. The report of this case contributes to updating knowledge about the safety aspects of treatment with teriflunomide and planning of monitoring strategies and patient risk management.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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