Infliximab-induced hepatitis: absence of cross-toxicity with etanercept

Joint Bone Spine. 2008 Dec;75(6):737-9. doi: 10.1016/j.jbspin.2007.12.009. Epub 2008 Aug 6.


We describe a patient presenting with acute hepatitis while receiving infliximab for ankylosing spondylitis. A slight increase in serum aminotransferases was first observed in this patient after 4 infusions of infliximab. The treatment was stopped after the 6th infusion when laboratory work-up revealed a 10-fold increase in serum levels of aminotransferases. A liver biopsy showed interportovenular bridging necrosis with macrophage accumulation consistent with the diagnosis of acute toxic hepatitis. After infliximab discontinuation, hepatic abnormalities resolved and the patient was treated with etanercept for more than 2 years without recurrence of hepatitis. This case underlines the lack of hepatic cross-toxicity between infliximab and etanercept making possible the continuation of anti-TNF-alpha therapy with etanercept in patients who have presented infliximab-related hepatic dysfunction.

Publication types

  • Case Reports

MeSH terms

  • Alanine Transaminase / blood
  • Antibodies, Monoclonal / adverse effects*
  • Antirheumatic Agents / adverse effects*
  • Aspartate Aminotransferases / blood
  • Chemical and Drug Induced Liver Injury / blood
  • Chemical and Drug Induced Liver Injury / etiology*
  • Chemical and Drug Induced Liver Injury / pathology
  • Etanercept
  • Humans
  • Immunoglobulin G / therapeutic use*
  • Infliximab
  • Male
  • Middle Aged
  • Necrosis / chemically induced
  • Necrosis / pathology
  • Receptors, Tumor Necrosis Factor / therapeutic use*
  • Spondylitis, Ankylosing / drug therapy*
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*
  • gamma-Glutamyltransferase / blood


  • Antibodies, Monoclonal
  • Antirheumatic Agents
  • Immunoglobulin G
  • Receptors, Tumor Necrosis Factor
  • Tumor Necrosis Factor-alpha
  • Infliximab
  • gamma-Glutamyltransferase
  • Aspartate Aminotransferases
  • Alanine Transaminase
  • Etanercept