A 75-year-old woman was referred to our hospital to undergo treatment for malignant melanoma (MM) on the external urethral orifice. She had undergone total cystostomy, ileal conduit, and pelvic lymphadenectomy. After 2 years, the right upper lung was resected because of lung metastasis of the MM. She was treated with nivolumab 3 mg/kg. On the following day, she developed a fever with mild liver dysfunction. On the 11th day, jaundice was found with severe liver dysfunction. Methylprednisolone 80 mg/day was given for liver dysfunction possibly induced by nivolumab. As the results of the laboratory tests improved, the steroid dose was gradually reduced. However, the liver dysfunction was exacerbated with the reduction of the steroid dose. After azathioprine (AZP) 100 mg/day was additionally administered, liver function test results indicated a return to normal ranges. We report a rare case of liver dysfunction that occurred the day after nivolumab administration and was successfully treated with steroids and additional AZP.[Skin Cancer (Japan) 2019 ; 34 : 192-197]
"},{"@language":"ja","@value":"75歳，女性。外尿道口原発の悪性黒色腫（MM）（T4bN0M0 stage IIc）に対し近医で膀胱全摘，回腸導管造設および骨盤内リンパ節廓清術を受けた。2年後，CT上で右肺上葉の小結節が見つかり胸腔鏡下右肺上葉部分切除術を受けた。病理所見からMMの肺転移と診断。術後補助療法としてニボルマブ（NIV）3 mg/kgが投与され翌日より発熱と軽度の肝障害がみられた。11日目には黄疸，Grade 3の高ビリルビン血症，Grade 2の肝逸脱酵素上昇を呈した。NIVによる肝障害としてメチルプレドニゾロン（mPSL）80 mg/日を開始。肝機能は改善したがステロイド減量に伴い肝障害の再燃を繰り返した。103日目よりアザチオプリン（AZP）100 mg/日を追加したところ肝機能は正常化した。9ヵ月経過した現在PSL 25 mg/日とAZPを継続中。MMの再発，転移はない。NIV単回投与により早期に重篤な肝障害を引き起こし再燃を繰り返したが，AZPが有効であった稀な症例であり，文献的考察を加えて報告する。
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