To the Editor: We were interested to read the recent case report on granulomatous hepatitis associated with etanercept therapy in a patient with rheumatoid arthritis (RA)1. We have also experienced hepatotoxicity with etanercept, although in a patient with psoriatic arthritis (PsA). A 50-year-old woman had a 20-year history of pustular psoriasis and PsA including arthritis mutilans. Psoriasis had been treated with combinations of topical and systemic drugs, including retinoids. Various nonsteroidal antiinflammatory drugs and disease-modifying antirheumatic drugs (DMARD) had been poorly tolerated or not effective. Episodes of toxicity included suspected allergic reactions (ibuprofen), raised transaminases (methotrexate), renal impairment (cyclosporine), and ...