Adalimumab-Induced Hepatocellular Injury in a Young Male With Hidradenitis Suppurativa and Underlying Metabolically Dysfunctional Liver Disease: A Case Report.

Adalimumab is widely used for the management of moderate-to-severe hidradenitis suppurativa (HS). We report the case of a 20-year-old male with Hurley stage 2-3 HS who developed progressively rising liver enzymes shortly after initiating adalimumab therapy. His alanine aminotransferase (ALT) level was 40 U/L at baseline, increased to 67 U/L one month after treatment, and continued to rise over the following year, reaching a peak of 139 U/L. Autoimmune serologies, ceruloplasmin, and viral hepatitis testing were all negative, effectively excluding autoimmune and viral etiologies. Abdominal ultrasound with elastography demonstrated grade 3 hepatic steatosis without fibrosis, consistent with underlying metabolic dysfunction-associated steatotic liver disease (MASLD). The isolated hepatocellular pattern of enzyme elevation, combined with the temporal association with adalimumab initiation and the exclusion of alternative causes, supported a diagnosis of adalimumab-associated drug-induced liver injury occurring on a background of MASLD. Adalimumab was discontinued, and the patient was counseled to begin structured lifestyle modification. This case highlights the importance of vigilant hepatic monitoring in patients receiving anti-TNF-α therapy, particularly those with metabolic risk factors that may increase susceptibility to liver injury.