Successful Treatment of Nivolumab-related Cholangitis with Prednisolone: A Case Report and Review of the Literature

Koji Sawada; Tatsuya Shonaka; Yuji Nishikawa; Kimiharu Hasegawa; Hidemi Hayashi; Takumu Hasebe; Shunsuke Nakajima; Katsuya Ikuta; Mikihiro Fujiya; Hiroyuki Furukawa; Toshikatsu Okumura

doi:10.2169/internalmedicine.2330-18

CASE REPORTS

Successful Treatment of Nivolumab-related Cholangitis with Prednisolone: A Case Report and Review of the Literature

Koji Sawada, Tatsuya Shonaka, Yuji Nishikawa, Kimiharu Hasegawa, Hidemi Hayashi, Takumu Hasebe, Shunsuke Nakajima, Katsuya Ikuta, Mikihiro Fujiya, Hiroyuki Furukawa, Toshikatsu Okumura

Author information

Koji Sawada
Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
Tatsuya Shonaka
Division of Gastroenterological and General Surgery, Department of Surgery, Asahikawa Medical University, Japan
Yuji Nishikawa
Division of Tumor Pathology, Department of Pathology, Asahikawa Medical University, Japan
Kimiharu Hasegawa
Division of Gastroenterological and General Surgery, Department of Surgery, Asahikawa Medical University, Japan
Hidemi Hayashi
Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
Takumu Hasebe
Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
Shunsuke Nakajima
Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
Katsuya Ikuta
Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
Mikihiro Fujiya
Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan
Hiroyuki Furukawa
Division of Gastroenterological and General Surgery, Department of Surgery, Asahikawa Medical University, Japan
Toshikatsu Okumura
Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Japan

Keywords: nivolumab-related cholangitis, prednisolone, eosinophils, immune-related adverse event, drug-induced liver injury

JOURNAL OPEN ACCESS

2019 Volume 58 Issue 12 Pages 1747-1752

DOI https://doi.org/10.2169/internalmedicine.2330-18

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Abstract

The patient was a 76-year-old man who was treated with nivolumab due to recurrent gastric cancer. A blood examination revealed grade 3 alkaline phosphatase (ALP) elevation. A histopathological examination revealed marked portal infiltration, including eosinophils and CD4+ and CD8+ T lymphocytes, suggesting nivolumab-related cholangitis accompanied by the features of both an immune-related adverse event (irAE) and drug-induced liver injury (DILI) with allergic reaction. The patient's ALP level immediately decreased after the administration of prednisolone. Although nivolumab-related cholangitis, a rare irAE, has been reported to be refractory to steroid therapy, patients with features of irAE and allergic DILI might immediately respond to prednisolone.

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