Infliximab and the Liver: A Hidden Autoimmune Mimic - Case Report and Literature Review

Infliximab is a tumour necrosis factor (TNF) - α inhibitor used in Crohn’s disease management. While generally safe, it has been implicated in rare cases of drug induced autoimmune-like hepatitis (DI-ALH), a distinct and serious form of drug-induced liver injury. We present a case of a 46-year-old woman with ileo-colonic Crohn’s disease presented with abnormal liver function tests three months after initiating infliximab therapy. Work-up excluded viral, metabolic, biliary, and vascular causes of liver injury. Autoimmune screen showed newly elevated titres for ANA, elevated IgG, and liver biopsy demonstrated interface hepatitis with plasma cells, lobular inflammation, and confluent necrosis; consistent with AIH. Infliximab was discontinued, and corticosteroids initiated, resulting in complete biochemical resolution. Maintenance for Crohn’s disease was switched to Vedolizumab and remained in clinical remission. Early diagnosis, drug cessation, and immunosuppressive therapy are crucial for recovery.