Third Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan.
Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Japan.
Intern Med. 2021 Jun 15;60(12):1847-1853. doi: 10.2169/internalmedicine.6535-20. Epub 2021 Jan 15.
A 72-year-old woman with advanced lung cancer had received systemic chemotherapy including atezolizumab. About three months after the initial administration of atezolizumab, her liver enzyme levels increased. The histopathological findings of the initial liver biopsy revealed acute inflammatory infiltrate, predominantly CD3, CD4 and CD8 T lymphocytes, in the hepatic lobules. We diagnosed her with atezolizumab-induced immune-related acute hepatitis. Oral corticosteroid therapy successfully improved the elevation of serum aminotransferases. A sequential liver biopsy demonstrated the rapid progression of liver fibrosis. Because hepatocellular carcinoma occurs most often in advanced cases of chronic liver disease, we should pay close attention to immune-related acute hepatic injury when treating patients with advanced liver diseases using atezolizumab.
一位 72 岁的晚期肺癌女性患者接受了包括阿替利珠单抗在内的全身化疗。在首次接受阿替利珠单抗治疗大约三个月后，她的肝酶水平升高。初次肝活检的组织病理学发现肝小叶内有急性炎症浸润，主要是 CD3、CD4 和 CD8 T 淋巴细胞。我们诊断她为阿替利珠单抗引起的免疫相关急性肝炎。口服皮质类固醇治疗成功改善了血清转氨酶升高。连续肝活检显示肝纤维化迅速进展。由于肝细胞癌最常发生在慢性肝病的晚期病例中，因此在用阿替利珠单抗治疗晚期肝病患者时，我们应密切关注免疫相关的急性肝损伤。
