免疫チェックポイント阻害薬関連肝炎ならびに胆管炎の1例

A case of immune checkpoint inhibitor-related hepatitis and cholangitis

免疫チェックポイント阻害薬（immune checkpoint inhibitor：ICI）は適応拡大に伴い，全身化学療法として多くの種類の悪性腫瘍に適応されている。しかし，その多くは正常臓器に対する過剰な免疫反応を惹起し，従来の癌治療にみられる有害事象とは異なる表現型の免疫関連有害事象（immune-related adverse events：irAE）を引き起こす。

We report a case of immune checkpoint inhibitor-related hepatitis and cholangitis. Administration of two immune checkpoint inhibitors（ICI）, nivolumab and ipilimumab, was started for the recurrence and metastasis of left renal cell carcinoma. After 88 days from the start of administration, laboratory findings suggested hepatitis and cholangitis as immune-related adverse events（irAE）, and the administration of ICI was discontinued. Liver specimen was consistent with irAE, so the steroid therapy was started, then laboratory findings were improved. Even if clinical symptoms are poor, irAE should be suspected if laboratory findings suggest hepatitis or cholangitis in the period of administration of ICI.