Introduction: Glatiramer acetate (Copaxone), a polypeptide has been approved for treating patients with active
relapsing–remitting multiple sclerosis.
Case Presentation: We report the first case of severe acute hepatitis after commencing treatment for multiple sclerosis
with glatiramer acetate. A 31-year-old female with multiple sclerosis presented with anorexia, lethargy and jaundice five
weeks after commencing glatiramer acetate. She had never received beta-interferon treatment. Investigations revealed a
bilirubin of 0.109 mmol/L (0.002-0.02 mmoL/L) and prothrombin time of 21 secs (9-15 secs). Her liver function tests
were normal before commencing glatiramer acetate. A liver biopsy performed approximately 6 weeks after
commencement of glatiramer acetate showed predominantly centrilobular hepatocyte necrosis with portal-venous
bridging, along with mild portal and interface hepatitis. The necrosis was not accompanied by an acute inflammatory or
chronic inflammatory infiltrate. The features were not suggestive of autoimmune hepatitis but consistent with drug
toxicity. The liver tests returned to normal within 2 months after cessation of glatiramer acetate.
Conclusion: Physicians should be aware that glatiramer acetate can be associated with uncommon but yet significantly
severe liver toxicity.