Internal Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA.
University of Kentucky College of Medicine, Lexington, Kentucky, USA.
BMJ Case Rep. 2023 Sep 25;16(9):e256879. doi: 10.1136/bcr-2023-256879.
We report a case of a woman in her 30s with a history of cholecystectomy, hypertension, type 2 diabetes and rheumatoid arthritis on methotrexate and certolizumab who presented with epigastric pain radiating to the right upper quadrant. Laboratory findings revealed significantly elevated liver enzymes consistent with hepatocellular liver injury. The hepatocellular pattern of liver injury, negative autoimmune serologies and improvement on cessation of certolizumab were consistent with drug-induced hepatotoxicity. We used Roussel Uclaf Causality Assessment Method to assess the likelihood of drug-induced liver injury that showed a score of 7, this was in line with a probable causality grading. Although the patient had a history of methotrexate use, the onset of symptoms and transaminitis coincided with the recent initiation of certolizumab, which was the trigger of hepatocellular injury. Liver enzymes also remained normal after the reinitiation of methotrexate on follow-up.
我们报告了一例 30 多岁的女性，有胆囊切除术、高血压、2 型糖尿病和类风湿关节炎的病史，正在服用甲氨蝶呤和西妥昔单抗。她出现了右上腹放射的腹痛。实验室检查发现肝酶显著升高，符合肝细胞损伤。肝细胞损伤模式、阴性自身免疫血清学和停止使用西妥昔单抗后的改善与药物性肝毒性一致。我们使用 Roussel Uclaf Causality Assessment Method 评估药物性肝损伤的可能性，显示评分为 7，这与可能的因果关系分级一致。尽管该患者有甲氨蝶呤使用史，但症状发作和转氨基酶升高与最近开始使用西妥昔单抗同时发生，这是肝细胞损伤的诱因。在随访中重新开始使用甲氨蝶呤后，肝酶也恢复正常。
