Anti-tumour necrosis factor treatment of severe psoriasis complicated by Epstein-Barr Virus hepatitis and subsequently by chronic hepatitis.
A case is described of severe acute hepatitis in 47-year-old woman with chronic psoriasis and psoriatic arthritis treated with infliximab. Although clinical, serological and laboratory results were compatible with acute EBV hepatitis, it was difficult to differentiate between EBV infection and other non-infectious causes of hepatitis. The patient gradually developed chronic hepatitis with liver steatosis and efficient treatment with adalimumab had to be stopped. This case presents an uncommon complication that may arise from the use of biologic therapy and calls for caution in long-term management of psoriatic patients with internal comorbidities.
Department of Dermatology and Venereology, Medical Faculty and Teaching Hospital Pilsen, Charles University, Czech Republic.
Petra
P
Cetkovska
Department of Dermatology and Venereology, Medical Faculty and Teaching Hospital Pilsen, Charles University, Czech Republic.
Iva
I
Lomicova
Department of Pathology, Medical Faculty and Teaching Hospital Pilsen, Charles University, Czech Republic.
Petr
P
Mukensnabl
Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands.
Aloysius C M
AC
Kroes
D000428:Alcohol Drinking / Q000009:adverse effects; D000998:Antiviral Agents / Q000627:therapeutic use; D001706:Biopsy; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000821:virology*; D005260:Female; D006521:Hepatitis, Chronic / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000821:virology*; D006525:Hepatitis, Viral, Human / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000821:virology*; D006801:Humans; D016867:Immunocompromised Host; D007155:Immunologic Factors / Q000009:adverse effects*; D000069285:Infliximab / Q000009:adverse effects*; D008875:Middle Aged; D009894:Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000821:virology*; D011565:Psoriasis / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D012074:Remission Induction; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000276:immunology
D000998:Antiviral Agents; D007155:Immunologic Factors; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab
biologic therapy; hepatitis Epstein-Barr virus; psoriasis