Acute severe immune mediated hepatitis due to pembrolizumab: a case report

Abstract

Cancer immunotherapy with immune checkpoint inhibitors has been widely accepted as a novel therapeutic
approach. However, in some cases they can generate autoimmunity with serious adverse events such as
immune-mediated acute hepatitis. We report the case of a female patient with a history of stage IV clear
cell renal cancer, undergoing treatment with Pembrolizumab/Axitinib who debuted with severe acute
hepatitis after one month of therapy. The laboratory parameters were indicative of liver failure with a
cholestatic pattern. Bile duct involvement was ruled out by cholangio-magnetic Resonance. Viral serology
and antinuclear antibodies were negative, while the protein electrophoresis was normal. Treatment with
intravenous methylprednisolone 250 mg and support measures was started after which the patients showed
a favorable evolution with improvement of her general condition and laboratory values. The importance of
excluding other aetiologies of severe hepatitis while on treatment with pembrolizumab as well as its timely
treatment is highlighted, since a good response is generally obtained after drug discontinuation and highdose corticosteroid therapy.