Diagnosis and treatment of a patient with severe hepatitis and rash caused by toripalimab: A case report.

RATIONALE: Immune-related adverse events have been frequently reported using immune checkpoint inhibitors. However, these reports are commonly observed in single-organ toxicity. Thus, the compound, multiple, multisite, and multi-organ toxicities are seldom recognized and lack treatment experience, finally leading to severe challenges in the clinical treatment of such patients. More case studies are needed to fully understand the diagnostic and treatment strategies formulti-organ immune-related adverse events. This report aims to share the clinical diagnosis and treatment experience of a patient with nasopharyngeal carcinoma who developed severe hepatitis and rash after treatment with toripalimab.

PATIENT CONCERNS: A 57-year-old male farmer was diagnosed with nasopharyngeal carcinoma. Ten days after treatment with the first cycle of terprilizumab combined with gemcitabine and cisplatin, the patient was admitted to the hospital for abnormal liver function tests. Two days after admission, the patient developed another rash.

DIAGNOSES: Based on the patient's past history, medication history, personal history, and relevant laboratory and imaging examinations, the liver injury and rash for this patient is probable caused by toripalimab.

INTERVENTIONS: The patient received methylprednisolone sodium succinate injection for anti-inflammatory, tiopronin and magnesium isoglycyrrhizate for hepatoprotective, fluticasone propionate cream and cetirizine for anti-allergic.

OUTCOMES: The patient's hepatitis and rash were effectively controlled after treatment, and no reoccurrence was observed during subsequent antitumor therapy.

LESSONS: This case proposes that clinician should comprehensively determine the risk of adverse reactions and strengthen medication monitoring to ensure patient safety.