Elevated Liver Enzymes in a Patient With Hepatocellular Carcinoma on Immune Checkpoint Inhibitor Therapy: A Diagnostic and Therapeutic Challenge.

We present a patient with untreated hepatitis C virus and metastatic hepatocellular carcinoma treated with combination immunotherapy who developed elevated liver enzymes. The immunotherapy was withheld, and the liver enzymes continued to rise. A liver biopsy was performed, which demonstrated findings consistent with chronic viral hepatitis. Direct-acting antiviral treatment was initiated, and the liver enzymes returned to normal limits. This case demonstrates the diagnostic dilemmas raised among patients with hepatocellular carcinoma on immunotherapy who develop elevated liver enzymes and some of the challenges regarding the use of these medications in patients with viremic hepatitis C virus.