Drug Induced-Hepatotoxicity with Concurrent Use of Adalimumab and Mesalamine for the Treatment of Crohn’s Disease

Case Summary: A 33-year old female with a history of Crohn’s disease presented with complaints of upper abdominal pain and bilious vomiting. She had been receiving Adalimumab and Mesalamine for treatment of Crohn’s disease. A liver panel revealed alkaline phosphatase (ALP): 188 IU/L, aspartate aminotransferase (AST): 1,638 IU/L, alanine transaminase (ALT): 592 IU/L, total bilirubin: 2.5 mg/dL, and direct bilirubin: 1.6 mg/dL. Adalimumab and Mesalamine were discontinued and by day 6 liver panel improved to ALP: 154 IU/L, AST: 57 IU/L, ALT: 163 IU/L, and total bilirubin: 0.8 mg/dL. Upon discharge Adalimumab was restarted and Mesalamine was discontinued.