Abstract
A 50-year-old woman was admitted for active rheumatoid arthritis (RA). She was found to have RA 1 year prior to this admission. Past history was unremarkable and she had no family history for rheumatic diseases. As nonsteroidal anti-inflammatory drug (NSAID) and methotrexate were not effective, etanercept was started (25 mg, twice a week). Mild elevation of alanine transaminase (ALT) and aspartate transaminase (AST) was found as an outpatient, and it was considered to be NSAID-induced liver injury. Two weeks after the first dose of etanercept, she developed progressive elevation of AST and ALT with right upper quadrant tenderness and hepatomegaly. Etanercept was discontinued and liver biopsy was performed, which demonstrated portal-area-dominant lymphoplasmacytic inflammatory cell infiltration. She was diagnosed as autoimmune hepatitis (AIH). Glucocorticoid was started with normalized liver function and stable joint symptoms. AIH was thought to be acutely aggravated by the administration of etanercept.
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Olsen NJ, Stein CM (2004) New drugs for rheumatoid arthritis. N Engl J Med 350:2167–2179
Roberts L, Mccoll GJ (2004) Tumor necrosis factor inhibitors: risks and benefits in patients with rheumatoid arthritis. Intern Med 34:687–693
Johnson PJ, McFarlane IG (1993) Meeting report: International Autoimmune Hepatitis Group. Hepatology 18:998–1005
Hartung AD, Bohnert A, Hackstein H et al (2003) Th2-mediated atopic disease protection in Th1-mediated rheumatoid arthritis. Clin Exp Rheumatol 21:481–484
Segal R, Dayan M, Zinger H et al (2003) The effect of IL-12 on clinical and laboratory aspects of experimental SLE in young and aging mice. Exp Gerontol 38:661–668
Becher B, Blain M, Giacomini PS et al (1999) Inhibition of Th1 polarization by soluble TNF receptor is dependent on antigen-presenting cell-derived IL-12. J Immunol 162:684–688
Lohr HF, Schlaak JF, Gerken G et al (1994) Phenotypical analysis and cytokine release of liver-infiltrating and peripheral blood T lymphocytes from patients with chronic hepatitis of different etiology. Liver 14:161–166
Krawitt EL (2006) Autoimmune hepatitis. N Engl J Med 354:54–66
Schweitzer IL, Peters RL (1974) Acute submassive hepatic necrosis due to methyldopa. A case demonstrating possible initiation of chronic liver disease. Gastroenterology 66:1203–1211
Sterling MJ, Kane M, Grace ND (1996) Pemoline-induced autoimmune hepatitis. Am J Gastroenterol 91:2233–2234
Gough A, Chapman S, Wagstaff K et al (1996) Minocycline induced autoimmune hepatitis and systemic lupus erythematosus-like syndrome. BMJ 312:169–172
Graziadei IW, Obermoser GE, Sepp NT et al (2003) Drug-induced lupus-like syndrome associated with severe autoimmune hepatitis. Lupus 12:409–412
Acknowledgment
A part of this report was presented in the 51st Annual General Assembly and Scientific Meeting of Japanese College of Rheumatology held in April 2007 in Yokohama, Japan.
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Harada, K., Akai, Y., Koyama, S. et al. A case of autoimmune hepatitis exacerbated by the administration of etanercept in the patient with rheumatoid arthritis. Clin Rheumatol 27, 1063–1066 (2008). https://doi.org/10.1007/s10067-008-0885-1
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DOI: https://doi.org/10.1007/s10067-008-0885-1