{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T16:04:49Z","timestamp":1781712289694,"version":"3.54.5"},"reference-count":13,"publisher":"S. Karger AG","issue":"1","license":[{"start":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T00:00:00Z","timestamp":1734912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2024,12,23]],"date-time":"2024-12-23T00:00:00Z","timestamp":1734912000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Case Rep Gastroenterol"],"abstract":"<jats:p>Introduction: We report the case of a man in his 50s with stage IVB non-small cell lung cancer who developed severe immune-related hepatitis caused by pembrolizumab. Case Presentation: He received carboplatin, pemetrexed, and pembrolizumab as first-line therapy. After four courses, each of the triplet regimen and maintenance therapy with pemetrexed and pembrolizumab, the patient developed immune-related pneumonitis and colitis. Therefore, pemetrexed and pembrolizumab were discontinued, and 0.5 mg\/kg\/day prednisolone was started. Despite gradual reduction of the prednisolone to 15 mg\/day along with resolution of the pneumonitis and colitis, hepatic dysfunction occurred (elevated serum bilirubin and transaminase levels). We made a diagnosis of immune-related hepatitis based on liver biopsy results and negative results for other causes, such as viral infection. We increased the prednisolone dose to 2 mg\/kg\/day; however, the hepatic dysfunction was not resolved. Upon sequential methylprednisolone pulse therapy (1,000 mg\/day), mycophenolate mofetil, and azathioprine treatment, the hepatic dysfunction plateaued but was not resolved. The patient did not respond to steroids for immune-related hepatitis, developed infectious enteritis owing to a compromised state, and died of sepsis on day 107 after diagnosis of immune-related hepatitis. Conclusion: This case highlights the importance of early diagnosis of steroid-refractory disease, prompt initiation of immunosuppressive agents, and steroid dose reduction in such cases. The changes in liver function during steroid non-response and immunosuppressive drug induction in this case are valuable as a reference for future cases of immune-related adverse event hepatitis. <\/jats:p>","DOI":"10.1159\/000542598","type":"journal-article","created":{"date-parts":[[2024,12,24]],"date-time":"2024-12-24T17:00:22Z","timestamp":1735059622000},"page":"14-21","source":"Crossref","is-referenced-by-count":2,"title":["Steroid-Refractory Immune-Related Hepatitis Caused by Pembrolizumab with Stage IVB Non-Small Cell Lung Cancer: A Case Report"],"prefix":"10.1159","volume":"19","author":[{"given":"Tomomi","family":"Hamaguchi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Makoto","family":"Ueno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Kobayashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shun","family":"Tezuka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manabu","family":"Morimoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terufumi","family":"Kato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haruhiro","family":"Saito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinya","family":"Sato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junji","family":"Furuse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shin","family":"Maeda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"127","published-online":{"date-parts":[[2024,12,23]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1080\/21645515.2016.1199310"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1801005"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v27.i32.5376"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2020.5012"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1111\/jgh.15041"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2020.02.041"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.2957\/kanzo.61.572"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.2957\/kanzo.63.107"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1002\/cnr2.1624"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1111\/pin.12812"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1002\/iju5.12101"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1155\/2021\/8870334"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1007\/s12328-023-01789-8"}],"container-title":["Case Reports in Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/karger.com\/crg\/article-pdf\/19\/1\/14\/4318488\/000542598.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/karger.com\/crg\/article-pdf\/19\/1\/14\/4318488\/000542598.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T15:01:23Z","timestamp":1745420483000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000542598"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,23]]},"references-count":13,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,1]]}},"URL":"https:\/\/doi.org\/10.1159\/000542598","archive":["Portico"],"relation":{"is-supplemented-by":[{"id-type":"doi","id":"10.6084\/m9.figshare.27750144","asserted-by":"subject"}]},"ISSN":["1662-0631"],"issn-type":[{"value":"1662-0631","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,23]]}}}