Article Text

Download PDFPDF
Certolizumab-induced liver injury: as assessed for causality by the updated RUCAM
  1. Muna Shakhashiro1,
  2. Rachel Crasta2 and
  3. Faiza Javed3
  1. 1Internal Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
  2. 2University of Kentucky College of Medicine, Lexington, Kentucky, USA
  3. 3Hospital Medicine, University of Kentucky, Lexington, Kentucky, USA
  1. Correspondence to Dr Faiza Javed; fja228{at}


We report a case of a woman in her 30s with a history of cholecystectomy, hypertension, type 2 diabetes and rheumatoid arthritis on methotrexate and certolizumab who presented with epigastric pain radiating to the right upper quadrant. Laboratory findings revealed significantly elevated liver enzymes consistent with hepatocellular liver injury. The hepatocellular pattern of liver injury, negative autoimmune serologies and improvement on cessation of certolizumab were consistent with drug-induced hepatotoxicity. We used Roussel Uclaf Causality Assessment Method to assess the likelihood of drug-induced liver injury that showed a score of 7, this was in line with a probable causality grading. Although the patient had a history of methotrexate use, the onset of symptoms and transaminitis coincided with the recent initiation of certolizumab, which was the trigger of hepatocellular injury. Liver enzymes also remained normal after the reinitiation of methotrexate on follow-up.

  • Gastrointestinal system
  • Biological agents
  • Drugs: musculoskeletal and joint diseases
  • Rheumatology

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: FJ, MS and RC. The following authors gave final approval of the manuscript: FJ, MS and RC.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.