Case Report Liver Transplant in a Patient under Methylphenidate Therapy: A Case Report and Review of the Literature Hoi Y. Tong, 1 Carmen Díaz, 2 Elena Collantes, 3 Nicolás Medrano, 1 Alberto M. Borobia, 1 Paloma Jara, 2 and Elena Ramírez 1 1 Department of Clinical Pharmacology, Hospital Universitario La Paz, IdiPaz, School of Medicina, Universidad Aut´ onoma de Madrid, Paseo de la Castellana 261, 28046 Madrid, Spain 2 Pediatric Hepatology Department, Hospital Universitario La Paz, IdiPaz, Paseo de la Castellana 261, 28046 Madrid, Spain 3 Pathological Anatomy Department, Hospital Universitario La Paz, IdiPaz, Paseo de la Castellana 261, 28046 Madrid, Spain Correspondence should be addressed to Elena Ram´ ırez; elena.ramirez@inv.uam.es Received 13 October 2014; Accepted 9 December 2014 Academic Editor: Seyed Mohsen Dehghani Copyright © 2015 Hoi Y. Tong et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Methylphenidate (MPH) is widely used in treating children with attention-deicit-hyperactivity disorder. Hepatotox- icity is a rare phenomenon; only few cases are described with no liver failure. Case. We report on the case of a 12-year-old boy who received MPH for attention-deicit-hyperactivity disorder. Two months later the patient presented with signs and symptoms of hepatitis and MPH was discontinued, showing progressive worsening and developing liver failure and a liver transplantation was required. Other causes of liver failure were ruled out and the liver biopsy was suggestive of drug toxicity. Discussion. One rare adverse reaction of MPH is hepatotoxicity. he review of the literature shows few cases of liver injury attributed to MPH; all of them recovered ater withdrawing the treatment. he probable mechanism of liver injury was MPH direct toxicity to hepatocytes. In order to establish the diagnosis of MPH-induced liver injury, we used CIOMS/RUCAM scale that led to an assessment of “possible” relationship. his report provides the irst published case of acute MPH-induced liver failure with successful hepatic transplantation. Conclusions. It is important to know that hepatotoxicity can occur in patients with MPH treatment and monitoring the liver’s function is highly recommended. 1. Introduction Methylphenidate hydrochloride (MPH) is a chain substi- tuted amphetamine derivative that primarily acts as nore- pinephrine-dopamine reuptake inhibitor. he Food and Drug Administration (FDA) irst approved MPH on 1955; however, it was not until the 1990s when MPH saw a dramatic increase in its prescription. In the PATS study almost one-third of the children revealed some side efects, mainly weight loss and neurological efects [1]. A few scattered and sporadic cases of hepatotoxicity with MPH treatment have been reported and usually referred to transient elevation of liver enzymes. his report describes a case of irreversible methylphenidate- induced liver failure. 2. Case Presentation A 12-year-old boy with no relevant medical history was treated with MPH at an appropriate dose of 30 mg daily for attention-deicit-hyperactivity disorder (ADHD), and no other treatment was received in the previous months. Ater two months of treatment, the patient presented with a 2-day history of generalized itching, malaise, fatigue, and anorexia and with no fever. At that time, MPH was discontinued. Initial aminotransferases (alanine aminotransferase, ALT; aspartate aminotransferase, AST), total bilirubin, and alkaline phos- phatase were elevated, while hepatitis panel (HBsAg, anti- HBcore, anti-HAV, anti-HIV, CMV IgM, and syphilis) was negative, and the patient’s health continued to worsen in Hindawi Publishing Corporation Case Reports in Pediatrics Volume 2015, Article ID 437298, 5 pages http://dx.doi.org/10.1155/2015/437298