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Leberwerterhöhung bei rheumatoider Arthritis

Differenzialdiagnostische Überlegungen an einem Fallbeispiel

Elevated liver enzymes in rheumatoid arthritis

Differential diagnostic considerations based on a case report

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Zusammenfassung

Leberwerterhöhungen bei Patienten mit rheumatoider Arthritis (RA) können unterschiedliche Ursachen haben. Diese reichen von der Grunderkrankung über Therapiefolgen bis zur (Erst-)Manifestation einer assoziierten Autoimmunerkrankung. Wir stellen den Fall einer 19-jährigen Patientin mit seropositiver RA vor, bei der unter antirheumatischer Therapie mit Adalimumab und Leflunomid nach etwa 9 Monaten ein drastischer Anstieg der Leberenzyme sowie der Cholestaseparameter auftrat. Daraufhin wurde die spezifische Therapie ausgesetzt. Außer der Grunderkrankung und der antirheumatischen Therapie kamen auch eine stattgehabte Behandlung mit Flucloxacillin sowie eine Assoziation zu einer zeitgleich diagnostizierten Zöliakie als mögliche Ursachen der Transaminasenerhöhung in Betracht. Nach mehrfacher Leberbiopsie wurde unter Annahme einer Autoimmunhepatitis mit Prednisolon und Azathioprin behandelt. Hierunter trat eine rasche Normalisierung der Leberwerte ein.

Abstract

Elevated liver enzymes in patients with rheumatoid arthritis may have various causes. These can range from the rheumatic disease itself, the anti-rheumatic medication or be the manifestation of an associated autoimmune disease. We present the case of a 19-year-old female with known seropositive rheumatoid arthritis who developed severe liver damage after 9 months of anti-rheumatic therapy with leflunomide and adalimumab. Both drugs were stopped. In addition to the underlying disease and the specific anti-rheumatic drugs, a temporary therapy with flucloxacillin as well as an association with newly diagnosed celiac disease had to be considered as possible causes of elevated liver enzymes. Following repeated liver biopsy, autoimmune hepatitis was assumed and prednisolone and azathioprine were initiated. Elevated liver enzymes and bilirubin rapidly returned to normal values.

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Danksagung

Unser herzlicher Dank gilt Prof. Dr. med. J. Rüschoff und Dr. med. E. Alexandrakis, Institut für Pathologie, Klinikum Kassel, für die freundliche Überlassung der histologischen Bilder mit den entsprechenden Erklärungen.

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Authors and Affiliations

  1. Fachklinik für Onkologie und Rheumatologie, Klinik „Am Kurpark“, Kurhausstraße 9, 97688, Bad Kissingen, Deutschland

    U. Hartmann &  M. Reuss-Borst

  2. Innere Medizin I Gastroenterologie, St. Elisabeth Krankenhaus GmbH, Bad Kissingen, Deutschland

    S. Schmitt

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  1. U. Hartmann
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  2. S. Schmitt
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  3. M. Reuss-Borst
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Correspondence to M. Reuss-Borst.

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Hartmann, U., Schmitt, S. & Reuss-Borst, M. Leberwerterhöhung bei rheumatoider Arthritis. Z. Rheumatol. 67, 440–444 (2008). https://doi.org/10.1007/s00393-008-0288-3

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