A case of non-comatose acute hepatic failure: An immune-related adverse event due to sequential administration of nivolumab and ipilimumab

Yamamoto Takafumi, Naitoh Takehito, Urano Fumihiro, Takada Yoshihisa, Tanaka Hitoshi, Higuchi Michio, Maeda Matsuki

doi:10.2957/kanzo.60.83

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Other Title

ニボルマブおよびイピリムマブの順次投与による免疫関連有害事象と考えられた非昏睡型急性肝不全の1例
症例報告ニボルマブおよびイピリムマブの順次投与による免疫関連有害事象と考えられた非昏睡型急性肝不全の1例
ショウレイホウコクニボルマブオヨビイピリムマブノジュンジトウヨニヨルメンエキカンレンユウガイジショウトカンガエラレタヒコンスイガタキュウセイカンフゼンノ 1レイ

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<p>A 77-year-old male patient visited us after undergoing a wide excision of a black spot on his right great toe in January 2016. He was diagnosed with stage IIIC melanoma. His malignancy recurred in the right inguinal lymph node in November 2016, for which he was initially treated with nivolumab. Because the progression of lymph node metastasis was observed even in July 2017, he was subsequently treated with ipilimumab. Marked increases in AST, ALT, and total bilirubin (T-Bil) levels were noticed 2 months after the initiation of ipilimumab, and 60 mg/day of methylprednisolone (mPSL) was accordingly administrated. Both AST and ALT levels decreased once, but then increased again; therefore, 500 mg/day of mPSL was further administered for 3 days. Thereafter, AST and ALT levels decreased again, while T-Bil level remained persistently elevated. The patient's condition suddenly deteriorated on day 23 of hospitalization, and he died on the same day. Based on our experience, we recommend early appropriate therapeutic intervention for liver injury by immune checkpoint inhibitors.</p>

Journal

Kanzo

Kanzo 60 (3), 83-90, 2019-03-20

The Japan Society of Hepatology

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