Black, JR;
Goldin, RD;
Foxton, M;
Marafioti, T;
Akarca, AU;
Pria, AD;
Brock, C;
... Pinato, DJ; + view all
(2019)
PD-L1 expressing granulomatous reaction as an on-target mechanism of steroid-refractory immune hepatotoxicity.
Immunotherapy
, 11
(7)
pp. 585-590.
10.2217/imt-2018-0187.
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Abstract
Immune-related hepatitis is an important toxicity from immune-checkpoint inhibitor therapy, affecting up to 20% of patients on dual cytotoxic T-lymphocyte antigen 4/programmed cell death 1 (CTLA-4/PD-1) inhibitors. The mechanisms underlying this type of drug-induced liver injury are poorly understood. We report the case of a patient with immune-checkpoint inhibitor-related hepatitis where the presence of a diffuse granulomatous, PD-L1-positive infiltrate on liver biopsy correlated with poor response to corticosteroids. Our findings suggest a potential role for activation of the PD-1 pathway within the histiocitic infiltrate as a mechanism of toxicity. Further studies should address the role of macrophages in this patient group characterized by steroid-refractoriness.
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