Infliximab-induced Hepatitis During Treatment of Vulvar Crohn's Disease

Caussé S, Bouquin R, Wylomanski S, Flamant M, Joubert M, Dréno B, Quéreux G

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 7years. 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 10days 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.