Pembrolizumab‐induced secondary sclerosing cholangitis in a non‐small cell lung cancer patient

Abstract

A 50-year-old woman with stage IV lung adenocarcinoma received seven cycles of pembrolizumab as third-line chemotherapy. Following the failure of pembrolizumab, she commenced fourth-line chemotherapy of docetaxel and ramucirumab. The patient complained of epigastric pain and a computed tomography (CT) scan revealed oedema-like thickening of the gallbladder wall, dilation of the bile ducts from the common to the intrahepatic bile ducts, and thickening of the common bile duct wall without any visible obstructions. Accumulation of fluorodeoxyglucose (FDG) in the gallbladder wall and bile duct was also detected with positron emission tomography (PET)-CT. A biopsy of the extrahepatic bile duct showed non-specific inflammation. Antibiotic treatment was not effective and pathogens were not detected. The patient was diagnosed with secondary sclerosing cholangitis (SSC) by pembrolizumab. She received 80 mg/day of prednisolone (PSL); however, SSC recurred with tapering of PSL. SSC then improved with steroid pulse therapy and subsequently 50 mg/day azathioprine and 80 mg/day PSL.

Immune-related cholangitis induced by immune checkpoint inhibitors: a systematic review of clinical features and management

“…Positron-emission tomography-computed tomography (PET-CT) was performed in two cases, one of which had increased fluorodeoxyglucose (FDG) uptake in the gallbladder and bile ducts [14]. The other patient had a negative result, probably because PET-CT was carried out 6 weeks before the abnormality of liver function test (LFT) [23].…”

“…The terms used for cholangitis induced by ICIs are confused. Large-ducts cholangitis has often been termed as ‘sclerosing cholangitis’ and ‘secondary sclerosing cholangitis (SSC) [10–15]. Small-ducts cholangitis has been named ‘cholangitis liver disease’, ‘cholangiopathy’, ‘biliary injury’ and so on [7,16–19].…”

Pneumonitis, appendicitis, and biliary obstruction during toripalimab treatment in a patient with extensive-stage small-cell lung cancer: a case report

“…In a report of ICIrelated cholangitis caused by pembrolizumab, CT showed edema-like thickening of the gallbladder wall and common bile duct with dilatation of the intrahepatic bile ducts. Magnetic resonance cholangiopancreatography (MRCP) showed irregular stenosis of the intrahepatic bile ducts and dilated peripheral bile ducts, and PET-CT showed increased uptake in the gallbladder wall and the gallbladder (57). In our patient, the CT showed intrahepatic and extrahepatic bile duct dilation and gallbladder enlargement without thickening of the gallbladder and bile duct walls.…”

Concurrent Nivolumab-Induced Gastritis and Cholangitis Accompanied by Biliary Tract Hemorrhage in a Patient With Stage IV Lung Adenocarcinoma

“…The use of tumor necrosis factor-α blockers is recommended for immune-related gastritis [ 1 ]. However, azathioprine or mycophenolate mofetil is reportedly used in most cases of refractory immune-related cholangitis [ 14 , 15 ]. The absence of reports of cholangitis treated with tumor necrosis factor-α blockers may be due to liver toxicity.…”