Sawada Koji, Shonaka Tatsuya, Nishikawa Yuji, Hasegawa Kimiharu, Hayashi Hidemi, Hasebe Takumu, Nakajima Shunsuke, Ikuta Katsuya, Fujiya Mikihiro, Furukawa Hiroyuki, Okumura Toshikatsu
Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan.
Division of Gastroenterological and General Surgery, Department of Surgery, Asahikawa Medical University, Japan.
Intern Med. 2019 Jun 15;58(12):1747-1752. doi: 10.2169/internalmedicine.2330-18. Epub 2019 Feb 25.
The patient was a 76-year-old man who was treated with nivolumab due to recurrent gastric cancer. A blood examination revealed grade 3 alkaline phosphatase (ALP) elevation. A histopathological examination revealed marked portal infiltration, including eosinophils and CD4+ and CD8+ T lymphocytes, suggesting nivolumab-related cholangitis accompanied by the features of both an immune-related adverse event (irAE) and drug-induced liver injury (DILI) with allergic reaction. The patient's ALP level immediately decreased after the administration of prednisolone. Although nivolumab-related cholangitis, a rare irAE, has been reported to be refractory to steroid therapy, patients with features of irAE and allergic DILI might immediately respond to prednisolone.
该患者为一名76岁男性，因复发性胃癌接受纳武单抗治疗。血液检查显示碱性磷酸酶（ALP）升高至3级。组织病理学检查显示有明显的门静脉浸润，包括嗜酸性粒细胞以及CD4+和CD8+ T淋巴细胞，提示纳武单抗相关胆管炎，伴有免疫相关不良事件（irAE）和药物性肝损伤（DILI）并伴有过敏反应的特征。给予泼尼松龙后患者的ALP水平立即下降。尽管据报道，纳武单抗相关胆管炎这种罕见的irAE对类固醇治疗无效，但具有irAE和过敏性DILI特征的患者可能会对泼尼松龙立即产生反应。
