{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T20:41:11Z","timestamp":1792269671410,"version":"4.4.0"},"reference-count":22,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["bpspubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacology Res &amp;amp; Perspec"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Tocilizumab is an interleukin\u20106 (IL\u20106) receptor antagonist indicated for various rheumatologic conditions. While hepatotoxicity is a recognized adverse effect, it predominantly manifests as hepatocellular injury. We report a rare case of drug\u2010induced liver injury (DILI) presenting with a cholestatic pattern and cholangitis features in a 75\u2010year\u2010old patient treated for giant cell arteritis. Following the third tocilizumab infusion, the patient developed jaundice and abdominal pain. Laboratory investigations revealed a cholestatic pattern of liver injury (ALT\/ALP (\n                    <jats:italic>R<\/jats:italic>\n                    ) ratio \u2264\u20092) with marked cholestasis. Imaging findings raised suspicion for cholangitis. After ruling out infectious, autoimmune, and metabolic aetiologies, a liver biopsy confirmed neutrophilic cholangitis and marked intrahepatic and sinusoidal cholestasis. Drug discontinuation, along with ursodeoxycholic acid treatment, led to clinical and biochemical resolution. This case is notable as tocilizumab\u2010induced liver injury rarely presents with cholangitic features. The pathophysiology may involve the disruption of IL\u20106 signaling, which plays a pivotal role in maintaining biliary epithelial integrity. Clinicians should be vigilant for this atypical cholestatic presentation to ensure prompt drug withdrawal.\n                  <\/jats:p>","DOI":"10.1002\/prp2.70323","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T04:58:38Z","timestamp":1790053118000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Drug\u2010Induced Liver Injury During Treatment With Tocilizumab: A Case Report of an Atypical Pattern Lesion"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-3179-2058","authenticated-orcid":false,"given":"Louis\u2010Edmond","family":"Barbaro","sequence":"first","affiliation":[{"name":"Department of Clinical Pharmacology Universit\u00e9 C\u00f4te d'Azur, University Hospital Centre of Nice  Nice 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France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6519-7756","authenticated-orcid":false,"given":"Elliot","family":"Ewig","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology Universit\u00e9 C\u00f4te d'Azur, University Hospital Centre of Nice  Nice France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raja","family":"Mroue","sequence":"additional","affiliation":[{"name":"Department of Gastro\u2010Enterology Universit\u00e9 C\u00f4te d'Azur, University Hospital Centre of Nice  Nice France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Amigues","sequence":"additional","affiliation":[{"name":"Department of Rheumatology Universit\u00e9 C\u00f4te d'Azur, University Hospital Centre of Nice  Nice France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6591-6966","authenticated-orcid":false,"given":"Alexandre O.","family":"G\u00e9rard","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacology Universit\u00e9 C\u00f4te d'Azur, University Hospital Centre of Nice  Nice France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.intimp.2022.109130"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1101\/cshperspect.a028456"},{"key":"e_1_2_9_4_1","unstructured":"European Medicines Agency \u201cRoActemra: EPAR\u2014Medicines Overview \u201d(2009) https:\/\/www.ema.europa.eu\/en\/documents\/overview\/roactemra\u2010epar\u2010medicines\u2010overview_en.pdf."},{"key":"e_1_2_9_5_1","unstructured":"European Medicines Agency \u201cRoActemra: EPAR\u2014Product Information \u201d(2010) 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