CASE REPORT article
Front. Immunol.
Sec. Cancer Immunity and Immunotherapy
Cases series of immune checkpoint inhibitor induced cholestatic hepatitis, acute renal injury and asymptomatic pancreatic enzyme elevation simultaneously
Provisionally accepted
- 1Peking Union Medical College Hospital department of Oncology, Beijing, China
- 2Peking Union Medical College Hospital Department of Medical Oncology(Xidan campus), Beijing, China
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Background: Immune checkpoint inhibitors (ICIs) have demonstrated promising antitumor activity. However, it may induce immune-related adverse events (irAEs). Multi-organ irAEs remain heterogeneous and incompletely characterized. We report a unique irAE pattern with synchronous hepatic, renal and pancreatic involvement which is first reported. Case Presentation: 5 males developed a rare multi-organ irAE pattern with concurrent cholestatic hepatitis, renal injury and pancreatic enzyme elevation, representing 0.40% of the ICI-treated cohort. The syndrome showed early, rapidly onset and often began with nonspecific complaints requiring close monitoring. Management: Responses of high dose glucocorticoid were varied by organs. Compared with renal and pancreatic injury, cholestatic hepatitis was less responsive to steroids. Out of 3 cases who were refractory to steroids, 2 cases were given artificial liver treatment and 1 case was given bilirubin adsorption after steroid failure. Outcomes: Immunosuppression by standard glucocorticoid showed limited efficacy in cholestatic hepatitis. The 2 patients received artificial liver support improved biochemically, while bilirubin adsorption alone provided only transient reduction of bilirubin in one case. As for final clinical outcome, one patient died from severe infection during therapy agianst irAE; one patient died from cancer progression despite irAE recovery; and the others achieved full recovery from this irAE combination.
Keywords: Cholestatic hepatitis, steroid-refractory toxicity, artificial liver therapy, immune checkpoint inhibitors, multi-organ immune-related adverse events
Received: 08 Aug 2025; Accepted: 29 Oct 2025.
Copyright: © 2025 Jiao, Wang, Ying, Nie, Leng, Liu, Zhang, Zhou and Bai. 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:
Na Zhou, zhouna@pumch.cn
Chunmei Bai, baichunmei@pumch.cn
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