Successful diagnosis and treatment of autoimmune hepatitis leading to liver failure following PD-1 immunotherapy in a patient with nasopharyngeal carcinoma: a case report.

BACKGROUND: Immune checkpoint inhibitors (ICIs), particularly programmed cell death protein 1 (PD-1) inhibitors, are widely used in oncology but can cause immune-related adverse events, including hepatotoxicity. Severe ICI-induced liver injury progressing to acute or subacute liver failure carries a poor prognosis and presents a significant management challenge.

CASE PRESENTATION: We present the case of a 58-year-old male with recurrent nasopharyngeal carcinoma who developed severe autoimmune hepatitis and subacute liver failure following his first cycle of tislelizumab (an anti-PD-1 antibody) combined with chemotherapy. Despite initial management with corticosteroids and hepatoprotective agents, his liver function deteriorated rapidly, characterized by progressive hyperbilirubinemia and coagulopathy. After transfer to a tertiary center, he was managed with high-dose intravenous methylprednisolone, mycophenolate mofetil, and three sessions of artificial liver support (plasma exchange and bilirubin adsorption). His liver function gradually stabilized and ultimately recovered. At follow-up, he achieved normal liver biochemistry and a good quality of life.

CONCLUSION: This case underscores the potential severity of ICI-induced hepatotoxicity. It highlights the critical importance of early recognition, prompt grading according to guidelines (e.g., CSCO), and aggressive, multimodal immunosuppressive therapy combined with artificial liver support in managing life-threatening immune-mediated liver failure. Close monitoring of liver function before, during, and after ICI therapy is essential.