Atay Beyza, Bozdogan Ali Berkcan, Yazarkan Yigit, Durak Muhammed Bahaddin
Department of Internal Medicine, Division of Gastroenterology, Hacettepe University, Ankara, TUR.
Department of Internal Medicine, Hacettepe University, Ankara, TUR.
Cureus. 2024 Oct 18;16(10):e71817. doi: 10.7759/cureus.71817. eCollection 2024 Oct.
Drug-induced autoimmune hepatitis (DI-AIH) is a condition that mimics autoimmune hepatitis both histologically and clinically, making diagnosis challenging. Ribociclib, a CDK4/6 inhibitor used in the treatment of metastatic breast carcinoma, has been associated with rare cases of DI-AIH. We present the case of a 46-year-old woman undergoing treatment with ribociclib for metastatic breast carcinoma, who developed fatigue, skin rash, and significantly elevated liver enzymes two months into therapy. Initial tests revealed ALT of 414 U/L and AST of 219 U/L, along with elevated IgG levels and positive antinuclear antibodies. A liver biopsy showed chronic active hepatitis with mixed inflammatory cell infiltrates, including plasma cells and eosinophils. Despite the discontinuation of ribociclib, the liver enzymes remained elevated, necessitating treatment with prednisolone and azathioprine. Over the course of six months, the patient's liver function improved, and immunosuppressive therapy was gradually tapered off. This case highlights the importance of recognizing ribociclib-induced DI-AIH and the effectiveness of immunosuppressive therapy in managing persistent liver injury.
药物性自身免疫性肝炎（DI-AIH）是一种在组织学和临床上都与自身免疫性肝炎相似的病症，这使得诊断具有挑战性。瑞博西尼是一种用于治疗转移性乳腺癌的CDK4/6抑制剂，与罕见的DI-AIH病例有关。我们报告了一例46岁接受瑞博西尼治疗转移性乳腺癌的女性病例，该患者在治疗两个月后出现疲劳、皮疹和肝酶显著升高。初始检查显示谷丙转氨酶（ALT）为414 U/L，谷草转氨酶（AST）为219 U/L，同时免疫球蛋白G（IgG）水平升高且抗核抗体呈阳性。肝脏活检显示慢性活动性肝炎，伴有混合性炎性细胞浸润，包括浆细胞和嗜酸性粒细胞。尽管停用了瑞博西尼，但肝酶仍持续升高，因此需要使用泼尼松龙和硫唑嘌呤进行治疗。在六个月的时间里，患者的肝功能有所改善，免疫抑制治疗逐渐减量。该病例强调了认识瑞博西尼诱导的DI-AIH的重要性以及免疫抑制治疗在处理持续性肝损伤方面的有效性。
