BACKGROUND: Infliximab (IFX) can induce elevation of hepatic aminotransferase levels. Hepatitis has been reported in patients treated with IFX and with risk factors such as viral hepatitis, alcohol intake, or concomitant use of hepatotoxic drugs. Liver disorders occurring in a patient without risk factors have rarely been reported, and liver biopsies to substantiate the liver changes have very rarely been described. The presence of lupus-like symptoms with newly positive antinuclear antibodies (ANAs), sometimes with double-stranded deoxyribonucleic acid (DNA) antibodies, has also been reported with IFX. Only a few articles have reported in detail these types of adverse events in patients with psoriasis. To our knowledge, the combination of lupus-like symptoms with simultaneous occurrence of a biopsy-proven hepatitis has not been reported with the use of IFX for psoriasis. OBJECTIVE: Description of a case of drug-induced hepatitis in a patient with concurrent clinical and serologic features of lupus induced by IFX. METHODS: We present the case of a 40-year-old woman with psoriasis who developed a biopsy-proven drug-induced hepatitis and concurrent lupus symptoms with positive ANAs while under IFX treatment. A review of related publications is presented. CONCLUSION: The clinician must be aware of uncommon side effects of IFX, such as liver anomalies and development of autoantibodies. Liver enzymes should be monitored regularly, and ANAs should be checked if liver enzymes are increasing and in the presence of lupus symptoms.
BACKGROUND:Infliximab (IFX) can induce elevation of hepatic aminotransferase levels. Hepatitis has been reported in patients treated with IFX and with risk factors such as viral hepatitis, alcohol intake, or concomitant use of hepatotoxic drugs. Liver disorders occurring in a patient without risk factors have rarely been reported, and liver biopsies to substantiate the liver changes have very rarely been described. The presence of lupus-like symptoms with newly positive antinuclear antibodies (ANAs), sometimes with double-stranded deoxyribonucleic acid (DNA) antibodies, has also been reported with IFX. Only a few articles have reported in detail these types of adverse events in patients with psoriasis. To our knowledge, the combination of lupus-like symptoms with simultaneous occurrence of a biopsy-proven hepatitis has not been reported with the use of IFX for psoriasis. OBJECTIVE: Description of a case of drug-induced hepatitis in a patient with concurrent clinical and serologic features of lupus induced by IFX. METHODS: We present the case of a 40-year-old woman with psoriasis who developed a biopsy-proven drug-induced hepatitis and concurrent lupus symptoms with positive ANAs while under IFX treatment. A review of related publications is presented. CONCLUSION: The clinician must be aware of uncommon side effects of IFX, such as liver anomalies and development of autoantibodies. Liver enzymes should be monitored regularly, and ANAs should be checked if liver enzymes are increasing and in the presence of lupus symptoms.
Authors: Susana Rodrigues; Susana Lopes; Fernando Magro; Hélder Cardoso; Ana Maria Horta e Vale; Margarida Marques; Eva Mariz; Miguel Bernardes; Joanne Lopes; Fátima Carneiro; Guilherme Macedo Journal: World J Gastroenterol Date: 2015-06-28 Impact factor: 5.742
Authors: Roberta Elisa Rossi; Ioanna Parisi; Edward John Despott; Andrew Kenneth Burroughs; James O'Beirne; Dario Conte; Mark Ian Hamilton; Charles Daniel Murray Journal: World J Gastroenterol Date: 2014-12-14 Impact factor: 5.742
Authors: Marwan Ghabril; Herbert L Bonkovsky; Clarissa Kum; Tim Davern; Paul H Hayashi; David E Kleiner; Jose Serrano; Jim Rochon; Robert J Fontana; Maurizio Bonacini Journal: Clin Gastroenterol Hepatol Date: 2013-01-17 Impact factor: 11.382
Authors: Hassan Riad; Samya Abu Shaikha; Hamda Al Ansari; Khalifa Al Naama; Hussein Al Sada; Mariam Al Mansoori Journal: Case Rep Dermatol Date: 2013-08-14