Abstract
To the Editor: A 37-year-old man was referred to our hospital with a 12-year history of severe plaque-type psoriasis without psoriatic arthritis. He did not drink alcohol. His only medication was omeprazole for a hiatal hernia. Six weeks after the third infusion of infliximab (5 mg/kg at weeks 0, 2, and 6), the patient complained of asthenia, abdominal pain, and arthritis of the wrist. No other drugs or alcohol were taken. Blood tests (Table I) showed a strong elevation in transaminase levels, without evidence of cholestatis, but with positive tests for antinuclear antibodies (ANA), double stranded DNA antibodies, and smooth muscle antibodies. Viral serologies were negative. Computed tomography of the liver was normal. No liver biopsy was performed. Spontaneously, the liver function tests (LFTs) became normal within 2 months, with a disappearance of the clinical symptoms. The hepatologist diagnosed autoimmune hepatitis (AIH). Infliximab was responsible for AIH for three reasons: (1) there was no other explanation for the AIH; (2) the delay of 10 weeks between the last infusion and the hepatitic damage; and (3) the spontaneous and complete recovery after stopping infliximab. Table IResults of blood tests after the third infusion of infliximab Laboratory tests Case 1 Case 2 Reference range ALT (IU L−1) 1126 768 10–45 AST (IU L−1) 424 584 10–65 Gamma glutamyl transferase (IU L−1) 240 425 5–65 Alakaline phosphatase (IU L−1) 181 391 30–130 Total bilirubin (pmol L−1) 13 54 0–20 Antinuclear antibody titer 1/200 1/2560 0–1/80 Anti-dsDNA (IU mL−1) 19.5 22,4 < 4.5 Anticardiolipin antibodies (GPL mL−1) 0 40 < 24 Anti–smooth muscle antibody titer 1/100 0 < 1/50 Antimitochondrial antibody titer 0 1/600 <1/50 Hepatitis A, B, and C serology 0 0 0 EBV and CMV serology 0 0 0 ALT, Alanine aminotransferase; AST, aspartate aminotransferase; CMV, cytomegalovirus; dsDNA, double stranded DN; EBV, Epstein–Barr virus; GPL, IgG phospholipid; IU, international unit. Open table in a new tab ALT, Alanine aminotransferase; AST, aspartate aminotransferase; CMV, cytomegalovirus; dsDNA, double stranded DN; EBV, Epstein–Barr virus; GPL, IgG phospholipid; IU, international unit.
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