The most serious adverse drug reaction of adalimumab (ADR) is tuberculosis reactivation. We describe a case of a 35-year-old man, with rheumatoid arthritis (RA) and hepatitis C virus genotype 1a with a liver biopsy in 2001 with a METAVIR score pattern A1 F0; he received interferon alpha 2b for six months, but treatment was suspended because of reactivation of RA. Liver function tests after treatment were similar to previous ones showing a minimal cholestatic pattern. In 2008, methotrexate was prescribed, but the drug was withdrawn at the third month because of the appearance of pruritus and Ggt rise. Viral load at that moment was 9300000？UI/mL, log 6,9. The liver biopsy showed a Metavir Score A2 F1. Adalimumab was started in 2010, and at the third month of treatment, Ggt showed a rise of 23 times normal value (NV), alkaline phosphatase 2,5 times NV with AST and ALT with no change. A new liver biopsy showed portal inflammation with eosinophils and a METAVIR A1 F2. We think that adalimumab appears to be responsible for the liver injury, because of temporal relationship, liver biopsy findings, other clinical conditions being discarded, and the improvement of clinical symptoms and biochemical abnormalities when adalimumab was suspended. 1. Introduction Adalimumab (Humira NR) is a fully humanized monoclonal antibody whose biologic target is tumor necrosis factor alpha (TNF-alpha). This pharmacodynamic mechanism diminishes inflammatory cytokines cascade. The label indications are nowadays rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, psoriasis, and Crohn’s disease. Clinical studies have demonstrated that the most frequent adverse drug reactions (ADRs) to this drug are the injection site reactions that occur in more than 10% of treated patients, and the most serious ADR is tuberculosis reactivation. Other serious systemic infections, which occur very rarely, are drug-induced systemic lupus erythematosus, lymphoma or demyelinating disease [1–4]. These same studies demonstrate that hepatotoxicity is a rare condition that occurs in less than 5% of treated patients, and asymptomatic elevation of liver enzymes is the most common manifestation of liver toxicity. 2. Case Report A 35-year-old male patient with a medical history of chronic hepatitis c virus (genotype 1a) since 1999 and rheumatoid arthritis (RA) treated with hydroxychloroquine was examined in the hepatology unit of our Hospital. He showed a liver biopsy done in 2001 with an A1 F0 Metavir score [5] and was treated with interferon alfa 2b (IFN), but this treatment was suspended at the
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