Background. Biologic therapy to inhibit tumor necrosis factor-alpha (TNF-α) is an effective, safe treatment for patients with inflammatory bowel disease (IBD). All TNF-α inhibitors have been associated with liver toxicity, but many of these cases have been reported in patients receiving therapy for rheumatologic disease. Herein we report the first single-center case series of TNF-α antagonist related liver injury in patients with IBD. Methods. A retrospective case series was performed at the Henry Ford Inflammatory Bowel Diseases Center. IRB approval was obtained. Results. 2 patients were treated with infliximab, whereas the 3rd patient was treated with adalimumab for IBD. All 3 patients had negative viral markers, normal autoimmune serologies, and normal biliary imaging studies. Liver biopsy was performed in all 3 patients, and evidence of portal inflammation was seen. Liver enzymes normalized after discontinuation of therapy in all patients, and no long term effects have been observed. One patient was successfully transitioned from infliximab to adalimumab without relapse of either IBD or liver injury. Conclusion. Liver injury secondary to TNF-α antagonist is an underrecognized, important clinical entity with potentially serious consequences. The mechanism of drug-induced injury is idiosyncratic. Larger cohort studies are needed to establish risk factors and injury patterns related to hepatotoxicity in these patients. 1. Introduction Biologic therapy to inhibit tumor necrosis factor-alpha (TNF-α), a proinflammatory cytokine, has become a widely used, safe, and effective treatment for patients with inflammatory bowel disease (IBD) [1]. Since 2008, the number of patients treated with TNF-α antagonists has rapidly increased, and as of 2011 more than 1,500,000 people have been exposed to infliximab therapy [2]. However, the side effect profile of these medications is still being established. TNF-α antagonists have been associated with the reactivation of latent tuberculosis, reactivation of hepatitis B, demyelinating neurologic disease, and congestive heart failure, among other adverse effects [3]. Cases of TNF-α antagonist-induced liver toxicity have been reported, but mainly in patients receiving therapy for rheumatologic disease [4–8]. Little has been reported about anti-TNF-α related hepatotoxicity in patients with IBD [2, 4, 9–12]. Clinician awareness of the adverse effects of commonly used therapies is paramount for safe administration of treatment. Herein we report the first single-center case series of anti-TNF-α related liver injury in patients
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