Severe hepatitis arising from ipilimumab administration, following melanoma treatment with nivolumab.
After 4 weeks of the last dose of nivolumab, a 59-year-old man with stage IV melanoma was subject to treatment with ipilimumab. After 5 weeks, the patient developed severe hepatitis, showing markedly elevated levels of both aspartate aminotransferase and alanine aminotransferase (>2000 U/l). Using pulse steroid therapy with 1000 mg/d of methylprednisolone, liver function initially improved, but then deteriorated upon dosage reduction. Subsequently, mycophenolate mofetil (MMF) was administered at a dose of 2 g/d in addition to the corticosteroid, which resulted in aspartate aminotransferase and alanine aminotransferase levels gradually improving to grade 1, and the corticosteroid dose was successfully reduced to 0.5 mg/kg/d of oral prednisolone. Liver function then remained stable when MMF was tapered. In conclusion, the use of MMF improved liver function in this patient with steroid-refractory hepatitis induced by immune checkpoint inhibitor administration.
Department of Dermatology, University of Tsukuba, Ibaraki, Japan.
Ryota
R
Tanaka
Department of Dermatology, University of Tsukuba, Ibaraki, Japan.
Yasuhiro
Y
Fujisawa
Department of Dermatology, University of Tsukuba, Ibaraki, Japan.|Department of Dermatology, Hitachi General Hospital, Ibaraki, Japan.
Inoue
I
Sae
Department of Dermatology, University of Tsukuba, Ibaraki, Japan.
Hiroshi
H
Maruyama
Department of Dermatology, Hitachi General Hospital, Ibaraki, Japan.
Shusaku
S
Ito
Department of Gastroenterology, University of Tsukuba, Ibaraki, Japan.
Naoyuki
N
Hasegawa
Department of Medical Oncology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
Ikuo
I
Sekine
Department of Dermatology, University of Tsukuba, Ibaraki, Japan.
Manabu
M
Fujimoto
D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use*; D056486:Chemical and Drug Induced Liver Injury / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D000074324:Ipilimumab / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008545:Melanoma / Q000188:drug therapy / Q000821:virology*; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000627:therapeutic use; D000077594:Nivolumab
D000911:Antibodies, Monoclonal; D000074324:Ipilimumab; D000077594:Nivolumab; D009173:Mycophenolic Acid
melanoma; ipilimumab; nivolumab; hepatitis; mycophenolate mofetil