Ulipristal acetate (UPA), a selective progesterone receptor modulator used for fibroid treatment, was associated with drug-induced liver injury (DILI) leading to regulatory restrictions. The unique histological finding on liver biopsy associated with UPA-induced DILI is:

• A Centrilobular necrosis with bridging fibrosis
• B Progesterone receptor modulator-associated endometrial changes (PAEC) — a similar vacuolated appearance in liver biopsies
• C Bile duct proliferation with cholestatic hepatitis pattern ✓
• D Massive hepatocellular necrosis resembling acute liver failure

Explanation

Ulipristal acetate (UPA/Esmya) was restricted by the European Medicines Agency (EMA) in 2020 due to cases of serious drug-induced liver injury (DILI) including liver failure requiring transplant. The hepatotoxicity pattern seen histologically is predominantly cholestatic hepatitis with bile duct proliferation, intrahepatic cholestasis, and inflammatory infiltrate — an immune-mediated idiosyncratic reaction. UPA is contraindicated in women with liver disease and requires monthly liver function monitoring. In India, UPA's use for fibroids has been similarly restricted pending safety review.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.