title: Infliximab-associated fulminant hepatic failure in ulcerative colitis: a case report.
abstract: BACKGROUND
  Infliximab, an antibody against tumor necrosis factor alpha, is used to treat inflammatory bowel disease and has well-established efficacy and proven safety. Complications of this treatment are related to immunosuppression and include higher risk of serious infections and malignant neoplasia. Although extremely rare, fulminant liver damage related to infliximab therapy has been reported.
  
  
  METHODS
  We present the case of a 38-year-old Afro-Brazilian woman with refractory ulcerative colitis who was started on infliximab. She had no previous history of liver disease, alcohol abuse, or infection. After the fifth dose of the medication, drug-induced liver injury was diagnosed. Treatment was discontinued but our patient's condition was aggravated by severe cholestasis and grade III/IV encephalopathy, requiring liver transplantation.
  
  
  CONCLUSIONS
  Drug-induced liver injury is an uncommon complication of infliximab. Current consensus recommends screening for liver dysfunction prior to and during therapy. This case emphasizes the need for vigilance and highlights a rare and potentially lethal complication.
authors.affiliation: Division of Coloproctology, Department of Surgery and Anatomy, Medical School of Ribeirão Preto, University of São Paulo, Avenida dos Bandeirantes, 3900, Ribeirão Preto, SP, Zip: 14048-900, Brazil. rogeriosparra@gmail.com.
authors.forename: Rogerio Serafim
authors.initials: RS
authors.lastname: Parra
authors.affiliation: Division of Coloproctology, Department of Surgery and Anatomy, Medical School of Ribeirão Preto, University of São Paulo, Avenida dos Bandeirantes, 3900, Ribeirão Preto, SP, Zip: 14048-900, Brazil. marleyfeitosa@yahoo.com.br.
authors.forename: Marley Ribeiro
authors.initials: MR
authors.lastname: Feitosa
authors.affiliation: Division of Coloproctology, Department of Surgery and Anatomy, Medical School of Ribeirão Preto, University of São Paulo, Avenida dos Bandeirantes, 3900, Ribeirão Preto, SP, Zip: 14048-900, Brazil. v_anfm@yahoo.com.br.
authors.forename: Vanessa Foresto
authors.initials: VF
authors.lastname: Machado
authors.affiliation: Department of Pathology, Medical School of Ribeirão Preto, University of São Paulo, Avenida dos Bandeirantes, 3900, Ribeirão Preto, SP, Zip: 14048-900, Brazil. lramalho@fmrp.usp.br.
authors.forename: Leandra Naira Zambelli
authors.initials: LN
authors.lastname: Ramalho
authors.affiliation: Division of Coloproctology, Department of Surgery and Anatomy, Medical School of Ribeirão Preto, University of São Paulo, Avenida dos Bandeirantes, 3900, Ribeirão Preto, SP, Zip: 14048-900, Brazil. jjrocha1@bol.com.br.
authors.forename: Jose Joaquim Ribeiro
authors.initials: JJ
authors.lastname: da Rocha
authors.affiliation: Division of Coloproctology, Department of Surgery and Anatomy, Medical School of Ribeirão Preto, University of São Paulo, Avenida dos Bandeirantes, 3900, Ribeirão Preto, SP, Zip: 14048-900, Brazil. omar.feres@hspaulo.com.br.
authors.forename: Omar
authors.initials: O
authors.lastname: Feres
mesh_terms: D000328:Adult; D056486:Chemical and Drug Induced Liver Injury / Q000473:pathology* / Q000628:therapy; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D000069285:Infliximab / Q000008:administration & dosage / Q000009:adverse effects*; D017114:Liver Failure, Acute / Q000139:chemically induced* / Q000628:therapy; D016031:Liver Transplantation; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D005765:Gastrointestinal Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab