Liver Injury Secondary to Anti-TNF-Alpha Therapy in Inflammatory Bowel Disease: A Case Series and Review of the Literature

Table 1

Patient	Patient 1	Patient 2	Patient 3
Age	49	34	19
Sex	Female	Female	Female
Disease	UC	UC	Crohn’s
Concomitant drugs	Mesalamine, synthroid	Mesalamine, synthroid, sertraline	None
TNF-α-antagonist	Infliximab	Infliximab	Adalimumab
Time to liver toxicity	18 months	3 months	1 month
Peak ALT	104	300	184
Peak AST	85	259	167
Total bilirubin	0.4	0.4	1.7
Direct bilirubin	0.1	0.1	1
Peak ALP	518	77	527
Albumin	3.3	4	3.2
INR	1.07	0.98	1.14
ANA	Negative	Negative	Negative
Anti-LKM	Negative	Negative	Negative
ASMA	N/A	Negative	Negative
Hep A IgM	Negative	Negative	Negative
Hep B sAg	Negative	Negative	Negative
Hep B core IgM	Negative	Negative	Negative
Hep C Ab	Negative	Negative	Negative
MRCP	Normal biliary system	Normal biliary system	Normal biliary system
Liver Biopsy	Chronic portal inflammation	Chronic portal inflammation	Lobular and chronic portal inflammation with microgranulomas
Outcome	Infliximab discontinued. Liver recovery in 8 weeks.; In clinical and endoscopic remission on ASA monotherapy	Switched to Adalimumab.; Liver recovery in 8 weeks.; In clinical and endoscopic remission	Adalimumab discontinued. Liver recovery in 6 weeks.; In clinical remission on no therapy

Ulcerative colitis (UC), Crohn’s disease (CD), aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), international normalized ratio (INR), antinuclear antibody (ANA), antismooth muscle antibody (ASMA), antiliver-kidney-mitochondrial antibody (anti-LKM), Hepatitis A immunoglobulin M (IgM), Hepatitis B surface antigen (HBsAg), Hepatitis B core antibody (cAb) IgM, Hepatitis C antibody (HCV Ab), and magnetic resonance cholangiopancreatography (MRCP).