[Infliximab-induced hepatitis during treatment of vulvar Crohn's disease]

Abstract

Background: We report a case of acute cytolytic hepatitis induced by infliximab in a patient with severe vulvar Crohn's disease.

Patients and methods: A 29-year-old Congolese woman presented with severe vulvar Crohn's disease active for 7 years. In view of resistance to standard medication (corticosteroids and metronidazole), treatment with infliximab 5mg/kg per injection was initiated. The patient developed acute cytolytic hepatitis 10 days after the first injection and the disease was asymptomatic. The various investigations confirmed the direct cytotoxicity of infliximab. A favourable outcome was gradually achieved after increasing the dosage of corticosteroids. At the same time, an improvement in the vulvar lesions was noted after this sole injection.

Discussion: Infliximab-induced is rare, with only 20 reported cases. The physiopathological mechanism is unknown and a number of aetiologies have been suggested.

Conclusion: This new case raises the issue of the need for routine liver function testing during infliximab therapy given the asymptomatic nature of this effect.