{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,29]],"date-time":"2026-03-29T20:19:29Z","timestamp":1774815569752,"version":"3.50.1"},"reference-count":9,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2023,9,13]]},"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.1136\/bcr-2023-256879","type":"journal-article","created":{"date-parts":[[2023,9,25]],"date-time":"2023-09-25T12:40:49Z","timestamp":1695645649000},"page":"e256879","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Certolizumab-induced liver injury: as assessed for causality by the updated RUCAM"],"prefix":"10.1136","volume":"16","author":[{"given":"Muna","family":"Shakhashiro","sequence":"first","affiliation":[{"name":"Internal Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel","family":"Crasta","sequence":"additional","affiliation":[{"name":"University of Kentucky College of Medicine, Lexington, Kentucky, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1931-5497","authenticated-orcid":false,"given":"Faiza","family":"Javed","sequence":"additional","affiliation":[{"name":"Hospital Medicine, University of Kentucky, Lexington, Kentucky, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,9,25]]},"reference":[{"key":"2025082700303865000_16.9.e256879.1","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(93)90101-6"},{"key":"2025082700303865000_16.9.e256879.2","first-page":"62","article-title":"Worldwide use of RUCAM for causality assessment in 81,856 idiosyncratic DILI and 14,029 HILI cases published 1993-mid 2020: A comprehensive analysis","volume":"7","author":"Teschke","year":"2020","journal-title":"Medicines (Basel)"},{"key":"2025082700303865000_16.9.e256879.3","doi-asserted-by":"crossref","first-page":"458","DOI":"10.3390\/diagnostics11030458","article-title":"Idiosyncratic drug-induced liver injury (DILI) and herb-induced liver injury (HILI): diagnostic algorithm based on the quantitative Roussel Uclaf causality assessment method (RUCAM)","volume":"11","author":"Teschke","year":"2021","journal-title":"Diagnostics (Basel)"},{"key":"2025082700303865000_16.9.e256879.4","doi-asserted-by":"crossref","first-page":"14","DOI":"10.3390\/ijms17010014","article-title":"RUCAM in drug and herb induced liver injury: the update","volume":"17","author":"Danan","year":"2015","journal-title":"Int J Mol Sci"},{"key":"2025082700303865000_16.9.e256879.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2014.07.062"},{"key":"2025082700303865000_16.9.e256879.6","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1111\/apt.13159","article-title":"New onset idiosyncratic liver enzyme elevations with biological therapy in in inflammatory bowel disease","volume":"41","author":"Shelton","year":"2015","journal-title":"Aliment Pharmacol Ther"},{"key":"2025082700303865000_16.9.e256879.7","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.jhep.2021.08.024","article-title":"Infliximab-induced liver injury: clinical phenotypes, Autoimmunity, and the role of corticosteroid treatment","volume":"76","author":"Bj\u00f6rnsson","year":"2022","journal-title":"J Hepatol"},{"key":"2025082700303865000_16.9.e256879.8","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2008.101659"},{"key":"2025082700303865000_16.9.e256879.9","first-page":"1017","article-title":"Risk and management of liver toxicity during methotrexate treatment in rheumatoid and Psoriatic arthritis: a systematic review of the literature","volume":"27","author":"Visser","year":"2009","journal-title":"Clin Exp Rheumatol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2023-256879","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T07:30:56Z","timestamp":1756279856000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2023-256879"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9]]},"references-count":9,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2023,9,25]]},"published-print":{"date-parts":[[2023,9]]}},"alternative-id":["10.1136\/bcr-2023-256879"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2023-256879","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9]]}}}