Fatal Cholestatic Liver Injury during Treatment with PD1 Immune Checkpoint Inhibitor for Malignant Melanoma: A Case Report

• Main Authors: Thuridur Thorsteinsdottir, Teje Løitegård, Henrik Mikael Reims, Alina Carmen Porojnicu
• Format: Article
• Language: English
• Published: Karger Publishers 2020-06-01
• Series: Case Reports in Oncology
• Subjects: immune checkpoint inhibitors; vanishing bile duct syndrome; malignant melanoma
• Online Access: https://www.karger.com/Article/FullText/507695

The use of immune checkpoint inhibitors has dramatically improved the chance of surviving malignant melanomas; however, the effect comes at the cost of toxicities that are difficult to predict. Immune-mediated hepatitis is the most common form of liver toxicity, but fatal outcome is uncommon. We report the case of a 70-year-old female with metastatic malignant melanoma who developed severe liver toxicity characterized by bile duct injury and cholestasis. The condition progressed despite potent immunosuppressive treatment, plasmapheresis, and intensive supportive care; and the patient died while still having tumor response.