Infliximab-induced autoimmune hepatitis

Abstract

Autoimmune hepatitis (AIH) is an inflammatory disorder of the liver with a wide spectrum of disease presentation, from asymptomatic elevations in liver-associated enzymes to acute liver failure. AIH is classically associated with elevated immunoglobulins and autoantibodies, although approximately 20% of patients with features of AIH lack circulating antibodies. Recently, tumour necrosis factor alpha inhibitors have been implicated in several cases of drug-induced AIH which impact treatment regimens for patients with inflammatory bowel disease (IBD). We present a case of infliximab-induced seronegative AIH responding to budesonide therapy with successful alteration of IBD treatment regimen to vedolizumab.

Keywords: drugs: gastrointestinal system; hepatitis other; ulcerative colitis.

Figure 1

H&E stain; 100× view of liver biopsy demonstrating mild to moderate portal and parenchymal inflammatory activity with focal interface hepatitis (arrow).

Figure 2

H&E; 400x view of the same biopsy featuring inflammatory cells, predominantly lymphocytes with scattered plasma cells (arrow), eosinophils (arrowhead) and macrophages.