SHM Converge Scientific Abstract ePoster Gallery-Immunotherapy Induced Hepatitis

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This case describes an 89-year-old man with recurrent non-small cell lung cancer and urothelial carcinoma who developed painless jaundice and weakness after starting pembrolizumab (Keytruda), a PD-1 immune checkpoint inhibitor. He had been tolerating treatment until the onset of progressive jaundice. On presentation, he was stable but markedly icteric and deconditioned, with a soft, non-tender abdomen and no organomegaly.<br /><br />Laboratory studies showed a cholestatic liver injury pattern with markedly elevated bilirubin (total 16.43 mg/dL, direct 13.66 mg/dL) and elevated liver enzymes (ALT 300–400 U/L, AST initially over 700 U/L). Kidney function was also impaired (creatinine 4.0). Workup for alternative causes was negative, including hepatitis panel, autoimmune markers (ANA, ASMA, AMA, MPO-ANCA, rheumatoid factor), acetaminophen/salicylate levels, and SPEP/UPEP.<br /><br />Imaging and gastroenterology evaluation did not identify an obstructive cause. Ultrasound, CT, MRCP, ERCP, and EGD showed only cholelithiasis and hydropic gallbladder without choledocholithiasis, biliary dilation, ampullary mass, or other acute pathology.<br /><br />Given the lack of another explanation, pembrolizumab-induced hepatitis was suspected. The drug was discontinued, and treatment with high-dose steroids and ursodeoxycholic acid (UDCA) was started. The patient showed rapid clinical and biochemical improvement, supporting the diagnosis of immune-related hepatitis.<br /><br />The report emphasizes that immune checkpoint inhibitors are now widely used in cancer treatment, but they can cause serious liver toxicity that may mimic other hepatobiliary diseases. Early recognition is essential because delayed diagnosis can lead to fulminant, potentially fatal hepatitis. Clinicians should maintain a high index of suspicion, and prompt withdrawal of the offending agent with steroid therapy can be effective.

Asset Subtitle

Cynthia C. Omenyi

Meta Tag

Author List Cynthia C. Omenyi, Pranali S. Pachika

Category Clinical Vignettes

Concept Immune Checkpoint Inhibitor

Concept Immunotherapy-Induced Hepatitis

Concept PD-1 Inhibitor

Concept Pembrolizumab

Concept Immune Checkpoint Inhibitor Toxicity

Distinguished Non-Finalist

Presenter Organization Upmc

Presenting Author Cynthia C. Omenyi

Track Adult

Keywords

pembrolizumab

immune checkpoint inhibitor

painless jaundice

cholestatic liver injury

immune-related hepatitis

non-small cell lung cancer

urothelial carcinoma

bilirubin elevation

high-dose steroids

ursodeoxycholic acid

Immune Checkpoint Inhibitor

Immunotherapy-Induced Hepatitis

PD-1 Inhibitor

Pembrolizumab

Immune Checkpoint Inhibitor Toxicity