Drug-induced liver injury secondary to anakinra in a patient with systemic juvenile idiopathic arthritis-Case report and literature overview.

BACKGROUND

Anakinra, an interleukin-1 receptor antagonist, is widely used to manage systemic juvenile idiopathic arthritis (sJIA) and related inflammatory conditions. While generally well tolerated, rare cases of drug-induced liver injury (DILI) have been reported.

METHODS

In addition to a literature review, we present a pediatric case of severe DILI attributed to anakinra. The case is of a 14-year-old male with sJIA complicated by macrophage activation syndrome (MAS) who developed DILI following the initiation of anakrina.

RESULTS

Anakrina was started after initial corticosteroid treatment. Following dose escalation, he developed a marked elevation in liver enzymes and cholestasis. Extensive workup, including a liver biopsy, excluded other causes and supported a diagnosis of anakinra-induced DILI. Discontinuation of anakinra led to the gradual normalization of liver function. Subsequent treatment with cyclosporine and tocilizumab was well tolerated.

CONCLUSIONS

Differentiating the liver enzyme elevation to MAS versus DILI is challenging but critical, as management strategies differ. Anakinra-induced liver injury appears to be an idiosyncratic, immune-mediated phenomenon that resolves on drug withdrawal. Our case highlights the importance of monitoring liver function during anakinra therapy and the role of liver biopsy in complex cases.