Hepatitis and Lupus-Like Syndrome during Infliximab Therapy for Psoriasis

Abstract

Biologics are very useful medications that changed the lives of many patients in the last decade. However, we still do not know about the long-term side effects of these drugs. Infliximab is an anti-TNF chimeric antibody widely used and approved for the treatment of many diseases. Lupus-like syndrome and hepatitis are among the uncommon side effects of infliximab. Most of the written literature was published for cases of rheumatology and gastroenterology. We report here a case of both hepatitis and lupus-like syndrome that occurred sequentially in the same patient and compare our finding with two case reports of the same side effects, drug and disease.

New onset idiosyncratic liver enzyme elevations with biological therapy in inflammatory bowel disease

“…Among the subgroup of patients in our study who underwent liver biopsy, all had an autoimmune hepatitis-like pattern of liver injury (an active hepatitis with interface activity and plasma cells, often with centrilobular hepatocyte necrosis/dropout), which is the commonest form reported in the literature. 12,13,15,18,19,21,23,[29][30][31] It is important to identify, as it can be severe requiring infliximab cessation and responds to treatment with corticosteroids. We could not identify any significant predictors that could differentiate definite from probable anti-TNF-induced liver injury, and specifically risk factors for autoimmune hepatitis on anti-TNF therapy.…”

Anti-tumour necrosis factor treatment of severe psoriasis complicated by Epstein-Barr Virus hepatitis and subsequently by chronic hepatitis

“…Concerning hepatological adverse events caused by anti-TNF treatment, mostly only elevated transaminases have been observed, although cases describing anti-TNF induced liver injury varying from acute liver failure to less severe cholestasis and reactivation of autoimmune hepatitis have recently been published (6)(7)(8). Hepatitis developing during anti-TNF therapy might result from both, infectious or noninfectious conditions, such as concomitant medication or autoimmune hepatitis.…”

Development of paradoxical inflammatory disorders during treatment of psoriasis with TNF inhibitors: a review of published cases

“…A total of seven clinical trials 7,8,[27][28][29][30][31] and four case reports [32][33][34][35] described a lupus-like syndrome, drug-induced lupus, or systemic lupus erythematosus. The clinical trials documented eight cases of 1749 patients treated with infliximab as well as one case among 567 patients treated with adalimumab.…”

“…Autoimmune hepatitis A total of four clinical trials 23,31,57,58 and six case reports [32][33][34]59,60 reported autoimmune hepatitis as an adverse effect to infliximab. Four of the patients were female, and two were male.…”

“…The patients in three of the case reports experienced lupus-like symptoms either concomitantly with or within 5 months of manifestations of autoimmune hepatitis. [32][33][34] Another of the cases was an overlap syndrome between autoimmune hepatitis and primary biliary cirrhosis. 59 All cases experienced remission either upon discontinuation of infliximab or treatment with corticosteroids and azathioprine.…”