{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,21]],"date-time":"2025-09-21T17:46:37Z","timestamp":1758476797090,"version":"3.44.0"},"reference-count":13,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T00:00:00Z","timestamp":1755561600000},"content-version":"unspecified","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,7,25]]},"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:p>We report a case of a man in his early 70s referred for Grade 2 immune checkpoint inhibitor induced liver injury (ChILI) post nivolumab and ipilimumab for metastatic melanoma. Despite treatment with immunosuppression, the liver enzymes improved but failed to normalise completely. Liver biopsy performed 6 months after diagnosis identified a severe hepatitis with interface and perivenular necroinflammatory activity. Mycophenolate was up-titrated to 1 g twice daily and prednisone 40 mg daily was commenced. Once liver enzymes normalised immunosuppression was then gradually withdrawn, with no recurrent elevation of the liver enzymes. This case demonstrates that there can be an incongruency between liver enzymes an histopathology in ChILI. As in our patient, this can have significant implications in managemen. Furthermore, this case is unique as there are no other reported cases in the literature of chronic ChILI.<\/jats:p>","DOI":"10.1136\/bcr-2025-265370","type":"journal-article","created":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T07:40:23Z","timestamp":1755589223000},"page":"e265370","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Discordance between biochemical and histological severity in persistent immune checkpoint inhibitor induced liver injury"],"prefix":"10.1136","volume":"18","author":[{"given":"Chloe","family":"Attree","sequence":"first","affiliation":[{"name":"Hepatology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia"},{"name":"Liver Transplant Unit, Toronto General Hospital, Toronto, Ontario, Canada"},{"name":"Hepatology, Toronto General Hospital, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel D.","family":"Saibil","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology and Hematology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandra","family":"Fischer","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Morven","family":"Cunningham","sequence":"additional","affiliation":[{"name":"Hepatology, Toronto General Hospital, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,8,18]]},"reference":[{"key":"2025081900401401000_18.8.e265370.1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.31227"},{"key":"2025081900401401000_18.8.e265370.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhepr.2020.100170"},{"key":"2025081900401401000_18.8.e265370.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhepr.2023.100719"},{"key":"2025081900401401000_18.8.e265370.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2019.02.014"},{"key":"2025081900401401000_18.8.e265370.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2022.10.001"},{"key":"2025081900401401000_18.8.e265370.6","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0134532","article-title":"A Mechanistic Assessment of the Discordance between Normal Serum Alanine Aminotransferase Levels and Altered Liver Histology in Chronic Hepatitis B","volume":"10","author":"Gong","year":"2015","journal-title":"PLoS ONE"},{"key":"2025081900401401000_18.8.e265370.7","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0b013e318154af74"},{"key":"2025081900401401000_18.8.e265370.8","unstructured":"LiverTox: clinical and research information on drug-induced liver injury. 2012. Available: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK548206\/"},{"key":"2025081900401401000_18.8.e265370.9","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1002\/cld.742","article-title":"Misconception: You Can\u2019t Have Liver Disease With Normal Liver Chemistries","volume":"12","author":"Lominadze","year":"2018","journal-title":"Clin Liver Dis (Hoboken)"},{"key":"2025081900401401000_18.8.e265370.10","doi-asserted-by":"publisher","DOI":"10.1111\/apt.17898"},{"key":"2025081900401401000_18.8.e265370.11","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2018-0174"},{"key":"2025081900401401000_18.8.e265370.12","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000038673","article-title":"Ultrasound-guided percutaneous liver biopsy: A review of what operators need to know","volume":"103","author":"Alturkistani","year":"2024","journal-title":"Medicine (Baltimore)"},{"key":"2025081900401401000_18.8.e265370.13","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2015.60.8448"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-265370","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T07:40:25Z","timestamp":1755589225000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-265370"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8]]},"references-count":13,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8,18]]},"published-print":{"date-parts":[[2025,8]]}},"alternative-id":["10.1136\/bcr-2025-265370"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-265370","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2025,8]]}}}