title: [Drug-induced liver injury with an autoimmune phenotype following anti-TNF Therapy - presentation of cases and review of literature].
abstract: Therapeutic agents to inhibit tumour necrosis factor alpha (TNF-α) have dramatically improved the treatment options for patients with autoimmune diseases. Common side effects include an increased susceptibility towards infection. Hepatic side effects are less frequently observed. Elevated liver function tests, hyperbilirubinaemia reactivation of chronic viral hepatitis or even acute liver failure have been described. Some cases have exhibited an autoimmune phenotype with the emergence of autoantibodies and characteristic histological lesions. We report on three patients who received anti-TNF therapy for psoriasis and presented with elevated liver function tests in the further course. Histological and serum analysis revealed an autoimmune phenotype of liver injury. In light of the growing use of anti-TNF therapies, drug-induced liver injury (DILI) with an autoimmune phenotype is an important side effect. Since the pathophysiological mechanisms related to the autoimmune phenotype of liver injury during TNF-inhibition are not well understood, the cases detailed herein should help treating physicians to improve their understanding of the situation.
authors.affiliation: I. Medizinische Klinik, Universitätsmedizin der Johannes Gutenberg Universität, Mainz.
authors.forename: S
authors.initials: S
authors.lastname: Rösner
authors.affiliation: Institut für Pathologie, Universitätsmedizin der Johannes Gutenberg Universität, Mainz.
authors.forename: A
authors.initials: A
authors.lastname: Schad
authors.affiliation: I. Medizinische Klinik, Universitätsmedizin der Johannes Gutenberg Universität, Mainz.
authors.forename: J
authors.initials: J
authors.lastname: Kittner
authors.affiliation: I. Medizinische Klinik, Universitätsmedizin der Johannes Gutenberg Universität, Mainz.
authors.forename: F
authors.initials: F
authors.lastname: Rahman
authors.affiliation: I. Medizinische Klinik, Universitätsmedizin der Johannes Gutenberg Universität, Mainz.
authors.forename: M A
authors.initials: MA
authors.lastname: Wörns
authors.affiliation: I. Medizinische Klinik, Universitätsmedizin der Johannes Gutenberg Universität, Mainz.
authors.forename: M
authors.initials: M
authors.lastname: Schuchmann
authors.affiliation: I. Medizinische Klinik, Universitätsmedizin der Johannes Gutenberg Universität, Mainz.
authors.forename: P R
authors.initials: PR
authors.lastname: Galle
authors.affiliation: I. Medizinische Klinik, Universitätsmedizin der Johannes Gutenberg Universität, Mainz.
authors.forename: J M
authors.initials: JM
authors.lastname: Schattenberg
mesh_terms: D000068879:Adalimumab; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects*; D001327:Autoimmune Diseases / Q000139:chemically induced* / Q000175:diagnosis* / Q000628:therapy; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab