• Renata de Medeiros Dutra, Fernanda Patrícia Jeronymo Pinto, Marcela Maria Silvino Craveiro, Julio Pinheiro Baima, Rogerio Saad-Hossne, Fernando Gomes Romeiro, and Ligia Yukie Sassaki.
• Department of Internal Medicine, São Paulo State University (Unesp), Medical School, Botucatu, Brazil.
• Medicine (Baltimore). 2024 Aug 2; 103 (31): e39095e39095.

RationaleUlcerative colitis (UC) is an inflammatory bowel disease (IBD) characterized by continuous inflammation of the colonic mucosa. Autoimmune hepatitis (AIH) is a chronic liver disease characterized by hypergammaglobulinemia, circulating autoantibodies, interface hepatitis, and favorable response to immunosuppression. An association between IBD and AIH is uncommon, and experts have suggested that in patients with overlapping IBD and AIH, the anti-tumor necrosis factor agents can be used. Therefore, this study reports a rare case of a patient with liver cirrhosis due to AIH and UC refractory to conventional treatment and discusses the risks and benefits of using anti-tumor necrosis factor in both conditions.Patient ConcernsA 28-year-old female presented with symptoms of diarrhea, abdominal pain, asthenia, and inappetence, accompanied by abdominal collateral circulation, anemia, alteration of liver enzymes, and elevation of C-reactive protein levels.DiagnosesThe patient underwent a liver biopsy, which was consistent with liver cirrhosis due to AIH. Colonoscopy showed an inflammatory process throughout the colon, compatible with moderately active UC.InterventionsThe patient received mesalazine, azathioprine, and corticotherapy, with no control of the inflammatory process. Faced with refractoriness to drug treatment and side effects of corticosteroids with an increased risk of severe infection due to cirrhosis, we opted to use infliximab for the treatment of UC. The patient presented with a clinical response and infliximab therapy was maintained.OutcomesEight months after starting infliximab therapy, the patient developed pneumonia with complications from disseminated intravascular coagulation and died.Lessons SubsectionsAIH is a rare cause of elevated transaminase levels in patients with UC. The best treatment to control the 2 conditions should be evaluated with vigilance for the side effects of medications, mainly infections, especially in patients with cirrhosis.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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