Department of Gastroenterology and Hepatology, University Hospital Cologne, Cologne, North Rhine-Westphalia, Germany
Department of Pathology, University Hospital Cologne, Cologne, North Rhine-Westphalia, Germany.
BMJ Case Rep. 2024 Sep 30;17(9):e260066. doi: 10.1136/bcr-2024-260066.
A woman in her 50s presented to the hospital with new-onset jaundice and ascites. Her medical history included a melanoma of the right shoulder, diagnosed 8 months before, for which she had received four cycles of ipilimumab and nivolumab. Due to the oncological history and previous immunotherapy, an immune-checkpoint-inhibitor (ICI)-induced hepatitis was suspected, and a high-dose corticosteroid treatment was initiated. However, as there was no improvement in the liver function tests, a percutaneous liver biopsy was performed for further diagnostic clarification. Histological analysis ultimately identified a hepatic sinusoidal obstruction syndrome (SOS) as the underlying cause of liver dysfunction and portal hypertension. ICI-related hepatic SOS represents an extremely rare adverse event related to immunotherapy that should be considered in all patients with treatment-refractory ICI-related hepatotoxicity and clinical signs of portal hypertension.
一位 50 多岁的女性因新发黄疸和腹水到医院就诊。她的病史包括 8 个月前被诊断出的右侧肩部黑色素瘤，为此她接受了 4 个周期的伊匹单抗和纳武单抗治疗。由于有肿瘤病史和既往免疫治疗史，怀疑为免疫检查点抑制剂（ICI）诱导性肝炎，并开始使用大剂量皮质类固醇治疗。然而，肝功能检查未见改善，因此进行了经皮肝活检以进一步明确诊断。组织学分析最终确定肝脏窦状隙阻塞综合征（SOS）是导致肝功能障碍和门脉高压的根本原因。ICI 相关的肝 SOS 是一种与免疫治疗相关的极其罕见的不良反应，对于治疗抵抗性的 ICI 相关肝毒性和门脉高压的临床体征的所有患者，都应考虑这一原因。
