# Certolizumab-Induced Liver Injury in Ankylosing Spondylitis: A Case Report and Causality Assessment

## TL;DR

A 34-year-old man with ankylosing spondylitis developed liver injury after treatment with certolizumab, highlighting the need for monitoring hepatotoxicity in such patients.

## Contribution

Reports a rare case of certolizumab-induced liver injury and confirms causality using the Roussel Uclaf Causality Assessment Method.

## Key findings

- Certolizumab led to elevated liver enzymes in a patient with ankylosing spondylitis.
- Causality between certolizumab and hepatotoxicity was confirmed using the Roussel Uclaf method.
- Liver enzymes normalized after discontinuation of certolizumab without recurrence.

## Abstract

Certolizumab-induced liver injury is exceptionally rare, with only a few cases reported in the literature. We present the case of a 34-year-old man with axial ankylosing spondylitis (AS) who developed a drug-induced liver injury following treatment with certolizumab. Despite the initial ineffectiveness of non-steroidal anti-inflammatory drugs and an inadequate response to infliximab, the patient achieved remission of AS symptoms with certolizumab. However, he subsequently developed elevated liver enzymes indicative of hepatocellular injury. Investigations excluded viral hepatitis and autoimmune liver diseases, pointing to certolizumab as the likely cause. The updated Roussel Uclaf Causality Assessment Method confirmed a probable causal relationship between certolizumab and hepatotoxicity. Discontinuation of certolizumab led to normalization of liver enzymes without recurrence of liver injury. This case highlights the need for vigilant monitoring for hepatotoxicity in patients receiving tumor necrosis factor inhibitors.