PMC3865702_01
DILIN subject 1. (A) Graphic summary of DILI caused by infliximab. Left vertical axis, serum enzymes (U/L); right vertical axis, serum total bilirubin (mg/dL); horizontal axis, time in days, with onset of DILI being day 0. Blue diamonds, serum AST; red squares, serum ALT; green triangles, serum Alk Phos; gray columns, serum total bilirubin; horizontal red arrow, duration of treatment with the anti-TNF-agent; vertical blue arrow, timing of liver biopsy. (B) Marked interface hepatitis with plasma cells (arrows) (H&E; original magnification, x600). (C) Zone 3 necrosis with inflammation and venulitis (arrow) (H&E; original magnification, x400).
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F1
Serum ALT fell to 198 U/L by 2 months after the last infusion but rose again to 1167 U/L, with a total bilirubin of 2.0 mg/dL (Figure 1 A1). A, B, and C was negative, and hepatic computed tomography and ultrasound were normal. A liver biopsy obtained 3 months after the last infliximab infusion showed portal and lobular mixed inflammatory infiltrate with autoimmune features and no fibrosis (Figure 1 A2 and A3).