Koya Yudai, Shibata Michihiko, Shinohara Nobuhiko, Nebuya Satoru, Oe Shinji, Honma Yuichi, Senju Michio, Sato Naoko, Harada Masaru
Third Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
Department of Pathology, University of Occupational and Environmental Health, Kitakyushu, Japan.
Hepatol Res. 2019 Aug;49(8):950-956. doi: 10.1111/hepr.13329. Epub 2019 Apr 10.
A 66-year-old man was admitted to our department due to cholestatic liver injury. He had received five cycles of pembrolizumab for small-cell lung cancer. Imaging showed the possibility of sclerosing cholangitis (SC) with hemobilia. Histologically, CD8 T cells had infiltrated the biliary epithelium of the extrahepatic bile duct. We reached the diagnosis of secondary SC induced by pembrolizumab. Although we treated him with high-dose corticosteroids, laboratory data showed only a moderate response. Clinicians should recognize that immune checkpoint inhibitors can sometimes cause severe and irreversible SC.
一名66岁男性因胆汁淤积性肝损伤入住我科。他因小细胞肺癌接受了5个周期的帕博利珠单抗治疗。影像学检查显示有硬化性胆管炎（SC）合并胆道出血的可能。组织学检查显示，肝外胆管的胆管上皮有CD8 T细胞浸润。我们诊断为帕博利珠单抗诱发的继发性SC。尽管我们用大剂量皮质类固醇对他进行了治疗，但实验室数据显示只有中度反应。临床医生应认识到免疫检查点抑制剂有时可导致严重且不可逆的SC。
