A case of autoimmune hepatitis exacerbated by the administration of etanercept in the patient with rheumatoid arthritis
A case of autoimmune hepatitis exacerbated by the administration of etanercept in the patient with rheumatoid arthritis
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DOI：
10.1007/s10067-008-0885-1
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发表时间：
2008-08-01
影响因子：
3.4
通讯作者：
Saito, Yoshihiko
中科院分区：
文献类型：
--
作者：
Harada, Koji;Akai, Yasuhiro;Saito, Yoshihiko
一名50岁女性因活动性类风湿关节炎（RA）入院。在此入院前1年，她被发现患有RA。既往病史无异常，家族史无风湿性疾病。由于非甾体抗炎药（NSAID）和甲氨蝶呤无效，开始使用依那西普（25mg，每周2次）。门诊发现轻度谷丙转氨酶（ALT）和天冬氨酸转氨酶（AST）升高，考虑为非甾体抗炎药所致肝损伤。首剂依那西普后2周，患者出现AST和ALT进行性升高，右上腹压痛和肝肿大。停用依那西普，肝活检显示门脉区淋巴浆细胞炎性细胞浸润。诊断为自身免疫性肝炎（AIH）。开始使用糖皮质激素时肝功能正常，关节症状稳定。AIH被认为是由依那西普的管理急性加重。
A 50-year-old woman was admitted for active rheumatoid arthritis (RA). She was found to have RA 1 year prior to this admission. Past history was unremarkable and she had no family history for rheumatic diseases. As nonsteroidal anti-inflammatory drug (NSAID) and methotrexate were not effective, etanercept was started (25 mg, twice a week). Mild elevation of alanine transaminase (ALT) and aspartate transaminase (AST) was found as an outpatient, and it was considered to be NSAID-induced liver injury. Two weeks after the first dose of etanercept, she developed progressive elevation of AST and ALT with right upper quadrant tenderness and hepatomegaly. Etanercept was discontinued and liver biopsy was performed, which demonstrated portal-area-dominant lymphoplasmacytic inflammatory cell infiltration. She was diagnosed as autoimmune hepatitis (AIH). Glucocorticoid was started with normalized liver function and stable joint symptoms. AIH was thought to be acutely aggravated by the administration of etanercept.