Infliximab-related hepatitis: discussion of a case and review of the literature.
Despite its rarity, infliximab-related hepatitis constitutes a cutting edge and challenging problem. In December 2004, a drug warning was issued by the Food and Drug Administration to alert healthcare professionals to the risk of hepatotoxicity in course of infliximab therapy. Subsequently, several reports of probable infliximab hepatitis have been published and interest is growing in trying to elucidate the impact of these events on clinical practice. After discussing our case report, the main characteristics of infliximab-mediated liver injury are analyzed, coupled with a review of the medical literature. Infliximab seems to provoke both immunomediated and a direct liver injury, but how this latter happens remains unclear. Moreover, infliximab immunomediated liver dysfunction resembles that of autoimmune hepatitis type I, with elevation of antinuclear, anti-smooth muscle, anti-double-strand DNA antibodies, and a clear preference for female sex. Finally, a flow chart is proposed with the purpose to help clinicians in the management of patients who develop signs of liver dysfunction during treatment with infliximab.
Mancini
Stefano
S
Department of Internal Medicine, University of Modena and Reggio Emilia, Policlinico di Modena-Medicina I, via Del Pozzo 71, Modena, Italy. mancini@adamember.org
Amorotti
Elisa
E
Vecchio
Sarah
S
Ponz de Leon
Maurizio
M
Roncucci
Luca
L
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D015535:Arthritis, Psoriatic / Q000188:drug therapy; D056486:Chemical and Drug Induced Liver Injury / Q000188:drug therapy / Q000276:immunology*; D019693:Hepatitis, Autoimmune / Q000276:immunology*; D006801:Humans; D000069285:Infliximab; D008297:Male; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab