Life threatening liver disease during treatment with monoclonal antibodies

doi:10.1136/bmj.b508

Published 18 February 2009, doi:10.1136/bmj.b508
Cite this as: BMJ 2009;338:b508

Endgames

Case report

Life threatening liver disease during treatment with monoclonal antibodies

Thorsten Kaiser, resident¹, Joachim Moessner, professor of medicine, head of department ¹, Keyur Patel, assistant professor of medicine ², John G McHutchison, professor of medicine², Hans L Tillmann, assistant professor of medicine¹^,2

¹ Medizinische Klinik und Poliklinik II, Universität Leipzig, 04103 Leipzig, Germany, ² Duke Clinical Research Institute, Durham, NC 27713, USA

Correspondence to: HL Tillmann hans.tillmann@duke.edu

The first 150 words of the full text of this article appear below.

A 66 year old man with an exacerbation of erythrodermic psoriasisdespite several weeks of treatment with efalizumab, a recombinanthumanised monoclonal antibody that binds to CD11a and acts asan immunosuppressant, was treated with adalimumab, a fully humanisedmonoclonal antibody that binds and deactivates tumour necrosisfactor ${alpha}$ (TNF ${alpha}$ ). Before starting treatment tuberculosis was excluded.The patient had no risk factors for infectious diseases andhad never received blood products.

Ten days after starting adalimumab, the patient developed jaundice.Blood tests showed the presence of the surface antigen of thehepatitis B virus (HBV) and higher than normal values of alanineaminotransferase (9.14 µkat/l; normal value <0.85 µkat/l), ${gamma}$ glutamyl transferase (2.92 µkat/l; <1.1 µkat/l),alkaline phosphatase (2.19 µkat/l; <2.15 µkat/l),and bilirubin (155 µmol/l; <20.5 µmol/l). Despiteappropriate treatment, he developed progressive coagulopathy(international normalised ratio 2.5), and his serum bilirubinincreased to more than 40 times the upper . . . [Full text of this article]