# Granulomatous Hepatitis Treated With Certolizumab Pegol

## TL;DR

A rare liver condition called idiopathic granulomatous hepatitis was successfully treated with certolizumab pegol after other treatments failed.

## Contribution

This is the first documented case of certolizumab pegol being used to treat idiopathic granulomatous hepatitis with antidrug antibodies.

## Key findings

- Certolizumab pegol showed novel efficacy in treating idiopathic granulomatous hepatitis.
- The patient developed antidrug antibodies to infliximab and adalimumab, making certolizumab pegol a viable alternative.
- Steroids and other conventional treatments like azathioprine and methotrexate were previously used but had limitations.

## Abstract

Idiopathic granulomatous hepatitis is a rare condition characterized by hepatic granulomas with constitutional symptoms such as recurrent fevers, myalgias, and hepatosplenomegaly in the absence of infection or inflammatory disorder. Typical treatment and course of this disease consist of a course of steroids with rapid symptom resolution. However, symptoms may recur when steroids are tapered. In these circumstances, azathioprine, methotrexate, infliximab, and adalimumab have demonstrated good response. In this case, we present a patient who developed antidrug antibodies to infliximab and adalimumab and was the first documented case of this disease to be treated with certolizumab pegol. Our case highlights the novel efficacy of certolizumab pegol for idiopathic granulomatous hepatitis and its role in treating idiopathic granulomatous hepatitis with antidrug antibodies.