Onset of Liver Damage after a Single??Administration of Infliximab??in??a Patient with Refractory??Ulcerative Colitis

Abstract

We report the case of a patient with refractory ulcerative colitis who developed cholestatic acute liver damage after a single infusion of infliximab. Unusual aspects of this case were the early onset (after the first administration) of liver damage and the absence of antinuclear antibodies, alcohol intake, hepatotoxic drugs and all known viral and metabolic causes of hepatic injury. Moreover, no serological or morphological findings of primary sclerosing cholangitis were observed. The patient's liver damage resolved spontaneously within 6 weeks. Although a direct relationship between administration of infliximab and onset of acute liver damage could not be definitely established, our case suggests that infliximab may induce direct liver damage, the course of which is similar to acute cholestatic hepatitis and resolves following withdrawal of the drug.

Hepatopancreatobiliary manifestations and complications associated with inflammatory bowel disease

“…207,208 There are also case reports of cholestatic liver disease in patients with CD using infliximab. [209][210][211] There is usually no clinical sequelae, with normalization of LFTs after stopping the agents. 211 Tumor necrosis factor-a (TNF-a) plays a major role in hepatocyte regeneration and interference with this mechanism could contribute to hepatotoxicity.…”

“…[209][210][211] There is usually no clinical sequelae, with normalization of LFTs after stopping the agents. 211 Tumor necrosis factor-a (TNF-a) plays a major role in hepatocyte regeneration and interference with this mechanism could contribute to hepatotoxicity. 212 Hepatotoxicity of infliximab was uncommon in clinical trials in IBD.…”

Infliximab-induced autoimmune hepatitis in Crohnʼs disease treated with budesonide and mycophenolate

“…To the best of our knowledge, there are only four reported cases of infliximab-induced autoimmune hepatitis in patients with inflammatory bowel disease. [1][2][3][4] Infliximab hepatitis appears indistinguishable from autoimmune hepatitis type 1 but direct hepatotoxicity cannot be excluded. Only one of the four reported cases had an elevated ANA titer (1:320).…”

Infliximab-related hepatitis: discussion of a case and review of the literature

“…The consultant confirmed the suspicion of an immunomediated hepatotoxicity, but, while awaiting virological blood test results, she suggested a detoxifying liver therapy with acetylcysteine [load dose 150 mg/kg (maximum 16.5 g) in 9 min, and then a maintenance dose of 300 mg/kg (maximum 11 g/day) in 24 h); such choice was suggested, since the cellular injury mechanism during infliximab treatment has not yet been clarified; moreover, recently a direct infliximab-related hepatotoxicity has also been documented [1], coupled with evidences of a relationship between tumor necrosis factor-alpha (TNF-a) and intracellular glutathione balance [2].…”