Anti-Tumor Necrosis Factor-alpha in therapy of severe alcoholic hepatitis: a case report

AIM OF THE STUDY The aim of this study is to evaluate the tolerance and effects of a single dose of infliximab combined with steroid therapy.
PATIENTS AND METHODS A 44-years old man patient with chronic alcohol abuse, obesity, dyslipidemia and diabetes with AH (Maddrey's score 32) received an association of prednisolone (80 mg/day ev) and infliximab (5 mg/kg once).
RESULTS At 2 weeks bilirubin decreased from 18.1 mg/dL to 6 mg/dL. At 4 weeks AST decreased from 1042 U/L to 154 U/L, ALT from 1112 U/L to 151 U/L, Maddrey's score decreased to 17.4. Infliximab was well tolerated, but after 5 weeks the patient suffered an adverse event characterized by fever, panniculitis, septicaemia of Staphylococcus aureus treated with specific therapy. At 60 days the patient was asymptomatic and the liver function tests were normal (Maddrey's score 10). At 6 months of follow-up: Maddrey's score 6.
CONCLUSIONS In AH, infliximab was well tolerated and associated with significant improvement in LFTs and Maddrey's score, but these promising results should encourage large trials assessing better the strategy of therapy and criteria for enrolment of the patients.