Carlsen K M, Riis L, Madsen O R
Department of Rheumatology, Gentofte University Hospital, Hellerup DK-2900, Denmark.
Clin Rheumatol. 2009 Aug;28(8):1001-3. doi: 10.1007/s10067-009-1179-y. Epub 2009 Apr 16.
We present a case of toxic hepatitis related to infliximab treatment in a 38-year-old woman with rheumatoid arthritis (RA). The patient had previously been treated with different disease-modifying drugs (DMARDs) alone or in combination but had never revealed signs of liver dysfunction. Due to high disease activity, treatment with infliximab (3 mg/kg i.v.) was initiated in combination with methotrexate (MTX) (25 mg/week) and folic acid (5 mg/week). The patient stopped MTX and folic acid on her own initiative after 3 weeks due to improvement of joint symptoms. After seven infusions, progressive elevations of the transaminases up to five times the upper normal limit were noted and treatment with infliximab was terminated. Serological tests for viral and autoimmune hepatitis and for ANA and anti-dsDNA were all negative. Specific infliximab antibodies could not be detected. Ultrasound of the liver was normal. Liver biopsy showed late signs of acute toxic hepatitis without MTX-related fibrosis. This is one the first cases that convincingly demonstrates that infliximab treatment may cause toxic hepatitis. Moreover, the case suggests a lack of hepatic cross-toxicity between infliximab and etanercept as the patient continued with etanercept without new episodes of liver dysfunction.
我们报告一例38岁类风湿关节炎（RA）女性患者，因英夫利昔单抗治疗导致中毒性肝炎。该患者此前单独或联合使用过不同的改善病情抗风湿药（DMARDs），但从未出现肝功能障碍迹象。由于疾病活动度高，开始使用英夫利昔单抗（静脉注射3mg/kg）联合甲氨蝶呤（MTX）（25mg/周）和叶酸（5mg/周）进行治疗。3周后，由于关节症状改善，患者自行停用了MTX和叶酸。七次输注后，转氨酶逐渐升高至正常上限的五倍，遂终止英夫利昔单抗治疗。病毒和自身免疫性肝炎以及抗核抗体（ANA）和抗双链DNA（anti-dsDNA）的血清学检查均为阴性。未检测到特异性英夫利昔单抗抗体。肝脏超声检查正常。肝活检显示急性中毒性肝炎的晚期征象，无MTX相关纤维化。这是首批令人信服地证明英夫利昔单抗治疗可能导致中毒性肝炎的病例之一。此外，该病例提示英夫利昔单抗与依那西普之间不存在肝交叉毒性，因为患者继续使用依那西普且未出现新的肝功能障碍发作。
