CASE REPORT article
Front. Immunol.
Sec. Cancer Immunity and Immunotherapy
This article is part of the Research TopicAdvancements in Antibody-Based Immunotherapy and Cancer Vaccines for Hepatocellular CarcinomaView all 10 articles
Case report of acute hepatorenal failure induced by third-Line treatment with tislelizumab in a Patient with Cholangiocarcinoma: Was Influenza Virus the Culprit?
Provisionally accepted
- 1Dalian Medical University, Dalian, China
- 2The Fifth People’s Hospital of Dalian, Dalian, Liaoning Province, China
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A 72-year-old male diagnosed with cholangiocarcinoma was initiated on third-line therapy comprising Tislelizumab and Anlotinib. Within four days of treatment,he developed fulminant hepatic injury concurrent with acute kidney injury . Despite aggressive management with high-dose glucocorticoids,hepatoprotective agents,comprehensive supportive care,and subsequent anti-infective therapy,his clinical status declined rapidly. In view of the grave prognosis and the family's decision to decline intensive interventions such as plasma exchange,the patient ultimately succumbed to multiorgan failure. This case highlights a potential synergistic interaction between concomitant infection (e.g.,influenza virus) and immune checkpoint inhibitor(ICI) therapy,possibly mediated through enhanced antigenic stimulation and loss of immunoregulatory control,culminating in exaggerated immune activation. This mechanism may have profoundly amplified ICI-related toxicity,leading to fatal multiorgan irAEs. Regarding the issue of immune storms,it is challenging for clinical practice to provide favorable outcomes for patients,and we need to remain highly vigilant.
Keywords: Immune-related adverse events, tislelizumab, H1N1 influenza A virus (IAV), immune storm, Intrahepatic cholangiocarcinoma (ICC)
Received: 20 May 2025; Accepted: 25 Nov 2025.
Copyright: © 2025 Zhang, Zhang, 尹 and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Bin Zhang
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