Idiosyncratic Drug-Induced Liver Injury in a Patient With Metastatic Melanoma.

This is a case of drug-induced liver injury (DILI) in a 75-year-old male patient with a history of metastatic melanoma, who initially presented with a syncopal episode causing a fall. Following stabilization in the emergency department (ED), the patient was found to have bilateral subdural hematomas, and later an MRI showed evidence of metastatic lesions in the brain with hemorrhagic conversion. These findings led to a prolonged inpatient stay in the intensive care unit and eventual development of pneumonitis, which was subsequently treated with hepatotoxic antibiotics despite initial labs showing mildly elevated liver enzymes. This multidrug regimen and coexisting immunotherapy for metastatic melanoma led to drug-induced liver toxicity, a diagnosis that resulted in decreased cognitive function and an eventual decision to place the patient in hospice. While the patient eventually made a full recovery, this case report emphasizes the importance of maintaining a high index of suspicion for drug-induced liver toxicity in patients with risk factors such as receiving immunotherapy. DILI remains a serious complication in patients receiving immunotherapy, especially when combined with hepatotoxic antibiotics. Due to its difficult identification and frequent asymptomatic presentation, early recognition and intervention play a key role in preventing this sequelae.