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This is a patient with locally advanced urothelial carcinoma treated with gemcitabine, carboplatin, and pembrolizumab, developed a mixed biochemical pattern of liver injury with predominantly cholangiopathic disease, treated with budesonide induction bridged into early administration of tocilizumab to achieve steroid-free biochemical remission. The patient had a concurrent diagnosis of cholecystitis deemed to be an irAE from ICI. Liver biopsy was consistent with IMCH with predominance of cholangiopathy. Treatment of the patient’s IMCH included a brief course of budesonide, azathioprine, ursodiol, and one dose of subcutaneous TCZ, yielding normalization of AST and ALT, and stabilization of ALP.

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Cholangiohepatitis with Extrahepatic Cholangiopathy and Cholecystitis Secondary to Immune Checkpoint Inhibitor Therapy

  • 章节

  • 发表日期：

    2025年

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  • Hao Chi Zhang,
  • Andres Urias Rivera,
  • Ethan Miller,
  • Yun Shin Chun,
  • Celia Robinson Ledet,
  • Lan Wang

摘要

This is a patient with locally advanced urothelial carcinoma treated with gemcitabine, carboplatin, and pembrolizumab, developed a mixed biochemical pattern of liver injury with predominantly cholangiopathic disease, treated with budesonide induction bridged into early administration of tocilizumab to achieve steroid-free biochemical remission. The patient had a concurrent diagnosis of cholecystitis deemed to be an irAE from ICI. Liver biopsy was consistent with IMCH with predominance of cholangiopathy. Treatment of the patient’s IMCH included a brief course of budesonide, azathioprine, ursodiol, and one dose of subcutaneous TCZ, yielding normalization of AST and ALT, and stabilization of ALP.