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Ann Rheum Dis 64:1519-1520 doi:10.1136/ard.2004.032821
  • Letter

Autoimmune hepatitis associated with infliximab in a patient with psoriatic arthritis

  1. V Germano1,
  2. A Picchianti Diamanti1,
  3. G Baccano1,
  4. E Natale2,
  5. A Onetti Muda2,
  6. R Priori1,
  7. G Valesini1
  1. 1Division of Rheumatology, University of Rome “La Sapienza”, Italy
  2. 2Department of Experimental Medicine and Pathology, University of Rome “La Sapienza”, Rome
  1. Correspondence to:
    Professor G Valesini
    Divisione di Reumatologia, Dipartimento di Terapia e Clinica Medica Applicata, Policlinico Umberto I, Viale del Policlinico, 00161 Roma, Italy; g.valesiniuniroma1.it
  • Accepted 14 March 2005

We read with interest the debate about liver toxicity of infliximab in psoriatic arthritis (PsA).1,2 We describe the case of a 53 year old woman with a 4 year history of refractory PsA who developed transaminasitis during infliximab treatment.

CASE REPORT

Despite combination treatment (ciclosporin 300 mg/day, fluocortolone 10 mg/day, and methotrexate (MTX)15 mg/week intramuscularly), disease activity was still high, and intravenous infliximab at 3 mg/kg was administered initially at weeks 0, 2, 6, 14 and then every 6 weeks. Ciclosporin was withdrawn.

Within 3 weeks she improved, fluocortolone was gradually stopped while methotrexate (MTX) 20 mg/week intramuscularly, was continued. After the sixth infusion, she developed a mild transaminasitis and MTX, initially tapered, was stopped. After the eighth infusion transaminases continued to rise and in the absence of any other plausible cause, infliximab was withdrawn.

She was admitted to our department with persistently high values of aspartate aminotransferase and alanine aminotransferase and a flare of PsA. …