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An 82-year-old woman with remote resected lung cancer later developed PD-L1-high metastatic squamous non-small cell lung cancer with thoracic and hepatic disease. After 4 pembrolizumab doses, mixed liver injury developed despite normal baseline liver chemistries. Viral hepatitis serologies were negative, liver ultrasound was unrevealing, and acetaminophen exposure remained a non-significant competing factor. Liver tests improved with corticosteroids but recurred after 2 pembrolizumab rechallenges, including a grade 3 event, prompting permanent discontinuation. Nivolumab was started after biochemical recovery and was tolerated for more than 3\u00a0years without recurrent hepatotoxicity. Follow-up PET-CT demonstrated durable metabolic resolution of thoracic and hepatic disease.<\/jats:p>","DOI":"10.1093\/omcr\/omag159","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T11:12:07Z","timestamp":1786705927000},"source":"Crossref","is-referenced-by-count":0,"title":["Nivolumab after recurrent pembrolizumab-associated hepatotoxicity in PD-L1-high metastatic squamous non-small cell lung cancer: a case report"],"prefix":"10.1093","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-5677-9736","authenticated-orcid":false,"given":"Adam","family":"Bowen","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, McLaren Greater Lansing Hospital , Michigan State University, 2900 Collins Rd, Lansing, MI 48910,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katlyn","family":"Wendel","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, McLaren 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