PMC10262312_01
T-cell infiltration in the setting of anti-PD-1 induced autoimmune hepatitis. Liver biopsy obtained during acute hepatitis demonstrates significant infiltration of CD3+ T-cells (A) and scattered CD25+ T-cells (B), as shown by immunohistochemistry staining for both markers, respectively.
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f1
An infectious workup was negative for any infectious etiology explaining her hepatitis, and a liver biopsy showed scattered apoptotic hepatocytes with lobular T-cell infiltrates (CD3+, CD8+, CD25+) but no steatosis or fibrosis ( Figure 1 ).
Graphical display of rising AST, ALT, and GGT over time in response to nivolumab therapy, refractory to steroids, mycophenolate, everolimus, IVIG, tacrolimus, rabbit ATG, and IVIG. There is subsequent down trending and persistent suppression of AST, ALT, and GGT following initiation of basiliximab, despite discontinuation of steroids and tacrolimus.
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f2
None of these interventions were successful in persistently suppressing her LFTs, which peaked at greater than 20 times the upper limit of normal (ALT peaked at 3856 U/L and AST peaked at 1117 U/L on day 249 status post the first nivolumab dose, and gamma-glutamyltransferase (GGT) peaked at 2577 U/L (reference range 7-68 U/L) on day 254 status post the first nivolumab dose) ( Figure 2 ), reflecting a grade 4 hepatitis.