Abstract
A woman in her 60s with hepatocellular carcinoma (HCC) and sustained virological response following hepatitis C-related cirrhosis underwent multiple systemic treatments for metastatic disease, including immune checkpoint inhibitors (ICIs). In May (20xx+10), she developed epigastric pain 15 days following sorafenib initiation. Laboratory tests indicated increased serum amylase levels, and abdominal computed tomography revealed diffuse pancreatic enlargement with peripancreatic inflammation, leading to a diagnosis of acute pancreatitis.
Typical etiologies of pancreatitis were considered unlikely based on clinical history, laboratory findings, and imaging results. The patient's condition deteriorated despite discontinuing sorafenib and intensive conservative management. Considering the refractory clinical course and prior ICI exposure, immune-related pancreatic injury was considered in the differential diagnosis. On day 6 of hospitalization, steroid pulse therapy was initiated, causing rapid clinical, biochemical, and radiological improvements.
Although drug-induced pancreatitis associated with sorafenib remains a crucial consideration, this case suggests that immunological mechanisms related to previous ICI therapy can contribute to pancreatic injury, even after treatment discontinuation. In the era of sequential systemic therapy for HCC, clinicians should consider immune-related pancreatic disorders in the differential diagnosis of pancreatitis, particularly in severe or treatment-refractory cases.
