Toxic hepatitis induced by infliximab in a patient with rheumatoid arthritis with no relapse after switching to etanercept
Toxic hepatitis induced by infliximab in a patient with rheumatoid arthritis with no relapse after switching to etanercept
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DOI：
10.1007/s10067-009-1179-y
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发表时间：
2009-08-01
影响因子：
3.4
通讯作者：
Madsen, O. R.
中科院分区：
文献类型：
--
作者：
Carlsen, K. M.;Riis, L.;Madsen, O. R.
我们报告一例38岁女性类风湿性关节炎（RA）患者因英夫利西单抗治疗引起的中毒性肝炎。患者既往接受过不同的疾病调节药物（DMARD）单独或联合治疗，但从未出现肝功能障碍的体征。由于高疾病活动性，使用英夫利西单抗（3 mg/kg i. v.）与甲氨蝶呤（MTX）（25 mg/周）和叶酸（5 mg/周）联合使用。患者3周后因关节症状改善主动停用MTX和叶酸。输注7次后，观察到转氨酶进行性升高至正常上限的5倍，并终止英夫利西单抗治疗。病毒性肝炎和自身免疫性肝炎以及ANA和抗dsDNA的血清学检测均为阴性。未检测到特异性英夫利西单抗抗体。肝脏超声检查正常。肝活检显示急性中毒性肝炎的晚期体征，无MTX相关纤维化。这是第一个令人信服地证明英夫利西单抗治疗可能导致中毒性肝炎的病例。此外，该病例表明英夫利西单抗和依那西普之间不存在肝脏交叉毒性，因为患者继续使用依那西普，未发生新的肝功能障碍。
We present a case of toxic hepatitis related to infliximab treatment in a 38-year-old woman with rheumatoid arthritis (RA). The patient had previously been treated with different disease-modifying drugs (DMARDs) alone or in combination but had never revealed signs of liver dysfunction. Due to high disease activity, treatment with infliximab (3 mg/kg i.v.) was initiated in combination with methotrexate (MTX) (25 mg/week) and folic acid (5 mg/week). The patient stopped MTX and folic acid on her own initiative after 3 weeks due to improvement of joint symptoms. After seven infusions, progressive elevations of the transaminases up to five times the upper normal limit were noted and treatment with infliximab was terminated. Serological tests for viral and autoimmune hepatitis and for ANA and anti-dsDNA were all negative. Specific infliximab antibodies could not be detected. Ultrasound of the liver was normal. Liver biopsy showed late signs of acute toxic hepatitis without MTX-related fibrosis. This is one the first cases that convincingly demonstrates that infliximab treatment may cause toxic hepatitis. Moreover, the case suggests a lack of hepatic cross-toxicity between infliximab and etanercept as the patient continued with etanercept without new episodes of liver dysfunction.