Certolizumab-associated autoimmune-like hepatitis

Tumour necrosis factor alpha (TNF-α) inhibitors are licensed for use in autoimmune conditions such as psoriasis, and there have been reported cases of liver injury associated with infliximab and adalimumab use. In this case report, we present a case of a woman in her early 30s who was commenced on certolizumab, another TNF-α inhibitor, for the management of her psoriasis, having previously trialled other biologics. Thereafter, she developed acutely deranged liver function and subsequently underwent a liver screen and liver biopsy. The histological changes demonstrated an acute severe hepatitis which supported the case of drug-induced liver injury secondary to certolizumab. Following the drug discontinuation, the patient's liver function tests normalised and, through ongoing follow-up, was noted to remain stable. This case highlights that drug-induced autoimmune-like hepatitis is associated across the TNF-α inhibitor class and must be taken into consideration when commencing any of them.