Acute Hepatitis with Positive Autoantibodies: A Case of Natalizumab-Induced Early-Onset Liver Injury.

Content Provider	Europe PMC
Author	Cunha-Silva, Marlone de Moraes, Priscilla Brito Sena de Carvalho, Pedro Rodrigues da Costa, Larissa Bastos Eloy Assis-Mendonça, Guilherme Rossi Lalli, Cristina Alba Fernandes, Gisele Conte Alves Monteiro, Fernanda Bocchi Lamas, Gustavo Manginelli Damasceno, Alfredo de Campos Mazo, Daniel Ferraz Sevá-Pereira, Tiago
Copyright Year	2022
Abstract	Patient: Female, 60-year-oldFinal Diagnosis: Natalizumab-induced liver injurySymptoms: Jaundice • pruritusMedication: —Clinical Procedure: Drug withdrawalSpecialty: Gastroenterology and HepatologyObjective:Unusual clinical course Background:Natalizumab is an anti-integrin monoclonal antibody used as an alternative treatment regimen for patients with autoimmune disorders, especially multiple sclerosis and Crohn’s disease. Natalizumab-induced liver injury has been rarely reported and may follow the first dose (with increases in liver enzymes usually after 6 or more days), or after multiple doses. In general, it is non-severe acute hepatitis (with a hepatocellular pattern) and autoantibodies can be positive, mainly anti-nuclear and anti-smooth muscle antibodies.Case Report:We are reporting the case of a 60-year-old woman diagnosed with multiple sclerosis previously treated with interferon-beta, dimethyl fumarate, and fingolimod, who presented jaundice 1 day after the first infusion of natalizumab. She had an early-onset acute hepatitis with aminotransferases levels higher than 1000 IU/L and total bilirubin almost 41 mg/dL. Anti-nuclear and anti-smooth muscle antibodies were positive and the histo-pathological analysis of the liver showed intrahepatic cholestasis associated with moderate necroinflammatory activity (subacute cholestatic hepatitis) and mild diffuse perisinusoidal fibrosis, which could be compatible with the hypothesis of drug-induced liver injury. The scenario of an autoimmune-like hepatitis led the medical team to start oral prednisone and she progressively improved in clinical and laboratory features. Serum levels of liver enzymes and bilirubin were normal within 3 months and there was no further increase after discontinuation of corticosteroid therapy.Conclusions:Physicians should be aware of the risk of early-onset acute hepatitis in patients starting natalizumab, especially women with multiple sclerosis. Treatment with corticosteroid for a few months may be beneficial.
Volume Number	23
PubMed Central reference number	PMC9252306
PubMed reference number	35767513
Journal	The American Journal of Case Reports [Am J Case Rep]
e-ISSN	19415923
DOI	10.12659/AJCR.936318
Language	English
Publisher	International Scientific Literature, Inc.
Publisher Date	2022-06-29
Access Restriction	Open
Rights License	This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) © Am J Case Rep, 2022
Subject Keyword	Chemical and Drug Induced Liver Injury Hepatitis Multiple Sclerosis Natalizumab
Content Type	Text
Resource Type	Article
Subject	Medicine