{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T17:05:16Z","timestamp":1784307916837,"version":"3.55.0"},"reference-count":18,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Immune\u2010mediated hepatitis caused by immune checkpoint inhibitors (ICIs) is typically suspected based on aminotransferase elevation; however, biochemical signals may be blunted in advanced cirrhosis, potentially delaying recognition. A 71\u2010year\u2010old woman with cirrhosis due to metabolic dysfunction\u2013associated steatohepatitis and Barcelona Clinic Liver Cancer stage B hepatocellular carcinoma refractory to transarterial chemoembolization started durvalumab plus tremelimumab therapy. The patient developed grade 3 immune\u2010mediated colitis requiring high\u2010dose corticosteroids, with sustained clinical remission. Despite only modest aminotransferase changes, serial non\u2010contrast computed tomographic volumetry revealed progressive liver volume loss from 1.71\u2009L pretreatment to 0.76\u2009L at death, accompanied by jaundice and coagulopathy leading to fatal liver failure. In evaluating the subsequent liver dysfunction, the patient remained afebrile, and imaging revealed no biliary obstruction or vascular thrombosis. Autopsy revealed CD8\u2010predominant T\u2010cell infiltration with lobular hepatitis and patchy necrosis, consistent with immune\u2010mediated hepatitis as the cause of death. The tumor burden was small without metastasis. This case highlights that ICI hepatitis can progress with minimal aminotransferase elevation in advanced cirrhosis, warranting multidimensional monitoring beyond aspartate aminotransferase\/alanine aminotransferase, including bilirubin, coagulation parameters, clinical decompensation, and quantitative imaging.<\/jats:p>","DOI":"10.1002\/ccr3.72806","type":"journal-article","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T04:55:33Z","timestamp":1779857733000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Autopsy\u2010Proven Immune\u2010Mediated Hepatitis With Rapid Liver Atrophy Despite Minimal Aminotransferase Elevation After Durvalumab Plus Tremelimumab Therapy for Hepatocellular Carcinoma: A Case Report"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-4331-6799","authenticated-orcid":false,"given":"Hidenobu","family":"Hara","sequence":"first","affiliation":[{"name":"Department of Gastroenterology Yokohama City Minato Red Cross Hospital  Yokohama Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Risa","family":"Katsumata","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Yokohama City Minato Red Cross Hospital  Yokohama Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ami","family":"Yoshinaga","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Yokohama City Minato Red Cross Hospital  Yokohama Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kotaro","family":"Amano","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Yokohama City Minato Red Cross Hospital  Yokohama Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hikari","family":"Ishii","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Yokohama City Minato Red Cross Hospital  Yokohama Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kei","family":"Onodera","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Yokohama City Minato Red Cross Hospital  Yokohama Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jyunko","family":"Nemoto","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Yokohama City Minato Red Cross Hospital  Yokohama Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryota","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Yokohama City Minato Red Cross Hospital  Yokohama Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harujiro","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Yokohama City Minato Red Cross Hospital  Yokohama Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shoichi","family":"Yokobori","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Yokohama City Minato Red Cross Hospital  Yokohama Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moe","family":"Yamashita","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Yokohama City Minato Red Cross Hospital  Yokohama Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroaki","family":"Matsumoto","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Yokohama City Minato Red Cross Hospital  Yokohama Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuomi","family":"Sakaki","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Yokohama City Minato Red Cross Hospital  Yokohama Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiori","family":"Ito","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Yokohama City Minato Red Cross Hospital  Yokohama Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takehito","family":"Asakawa","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Yokohama City Minato Red Cross Hospital  Yokohama Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kouhei","family":"Yoshino","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Yokohama City Minato Red Cross Hospital  Yokohama Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiro","family":"Kumagai","sequence":"additional","affiliation":[{"name":"Department of Pathology Yokohama City Minato Red Cross Hospital  Yokohama Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinya","family":"Sakita","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Yokohama City Minato Red Cross Hospital  Yokohama Kanagawa Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/EVIDoa2100070"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2025.03.033"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1158\/1078\u20100432.CCR\u201021\u20101258"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1915745"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(25)00403\u20109"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.21.01440"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/jitc\u20102023\u2010007409"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.14309\/ajg.0000000000000398"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/hepr.14078"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/23247096241261505"},{"key":"e_1_2_13_12_1","volume-title":"Common Terminology Criteria for Adverse Events (CTCAE) v6.0 (MedDRA 28.0)","author":"Cancer Therapy Evaluation Program (CTEP), Division of Cancer Therapy and Diagnosis, National Cancer Institute (NCI)","year":"2025"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1155\/2019\/6391712"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaut.2020.102514"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics14080815"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2025.02.034"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.15920"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1080\/17425255.2019.1574744"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhepr.2020.100170"}],"container-title":["Clinical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.72806","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccr3.72806","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.72806","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T16:20:06Z","timestamp":1784305206000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccr3.72806"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,26]]},"references-count":18,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1002\/ccr3.72806"],"URL":"https:\/\/doi.org\/10.1002\/ccr3.72806","archive":["Portico"],"relation":{},"ISSN":["2050-0904","2050-0904"],"issn-type":[{"value":"2050-0904","type":"print"},{"value":"2050-0904","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,26]]},"assertion":[{"value":"2026-04-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-20","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e72806"}}