The Pembrolizumab Puzzle: Hepatic Complications of Immunotherapy

Jasdeep Bathla^1, , George Kidess², Kenan Abouchaer¹, Ayman Salem¹ and Dana Kabbani¹

¹Department of Internal Medicine, Detroit Medical Center/Wayne State University, Detroit, MI, USA

²Wayne State University School of Medicine, Detroit, MI, USA

Cite this paper:
Jasdeep Bathla, George Kidess, Kenan Abouchaer, Ayman Salem and Dana Kabbani. The Pembrolizumab Puzzle: Hepatic Complications of Immunotherapy. American Journal of Medical Case Reports. 2025; 13(2):9-11. doi: 10.12691/ajmcr-13-2-2

Abstract

Immune checkpoint inhibitors, or ICI’s, are an advanced immunotherapy that is increasingly used in a range of malignant disorders. Given such widespread use, attention to the side effect profile of these agents is needed given an array of complications, specifically, drug-induced liver injury (DILI). Although rarely encountered, DILI can be life-threatening given the precarious prognosis of this patient population. We present a case of DILI due to a specific subset of ICI’s known as programmed cell death protein 1 (PD-1) inhibitors which unfortunately resulted in a fatal outcome. The patient had history of relapsed Hodgkin's lymphoma on salvage immunotherapy with pembrolizumab and despite appropriate management, ultimately succumbed to multiorgan failure. Despite potential for such disastrous outcomes, this class of medications remains relatively safer than alternative therapies. This case highlights a specific deleterious effect of this drug class while advocating for further investigation into the link between ICI use and DILI.

Keywords:
pembrolizumab immune checkpoint inhibitor immunotherapy drug induced liver injury

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