scholarly journals A good response to steroid therapy in IgG4-related sclerosing cholangitis: a case report

2018 ◽  
Vol 4 (3) ◽  
pp. 205-209
Author(s):  
Jingqiao Zhang ◽  
Xiaozhong Guo ◽  
Hongyu Li ◽  
Xiaodong Shao ◽  
Jiao Deng ◽  
...  
Keyword(s):  
Case Report ◽  
Steroid Therapy ◽  
Sclerosing Cholangitis

scholarly journals A205 PEMBROLIZUMAB ASSOCIATED SCLEROSING CHOLANGITIS RESPONDS TO COMBINATION OF STEROIDS AND MYCOPHENOLIC ACID: A CASE REPORT

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 233-234
Author(s):  
X Zhao ◽  
R Huang ◽  
Y Chen ◽  
M Deschênes
Keyword(s):  
Case Report ◽  
Bile Duct ◽  
Steroid Therapy ◽  
Sclerosing Cholangitis ◽  
Case Reports ◽  
Case Series ◽  
Frequent Pattern ◽  
Free Fluid ◽  
Check Point ◽  
Organ Systems

Abstract Background Pembrolizumab is a check point inhibitor that targets programmed cell death receptor ligand 1 (PD-L1). However, check-point inhibitors are associated with its characteristic adverse event know as immune related adverse events that can affect a myriad of organ systems. In the hepatobiliary system, the most commonly described iRAE is hepatitis/hepatotoxicity and latest oncology guidelines offer recommendations on treatment and followup of immunotherapy related hepatitis (1). However, a more rare presentation of iRAE, that have only been described as case reports or case series, is secondary cholangitis. We report one of such a case. Aims Case report Methods Case report Results The patient is a 55 year-old Caucasian female know for lung adenocarcinoma presented to the emergency room on May 5th, 2020, having received her 8th cycle of pembrolizumab. Her blood works mildly elevated transaminitis; ALT 78 U/L, AST 11 U/L, alkaline phosphate of 130 U/L, and total bilirubin of 3.5 umol/L. MRI of the abdomen showed a normal appearing liver without focal parenchymal lesion, no biliary stones or obstructing masses, dilated common bile duct at 11 mm with small pericholecystic free fluid, and normal gall badder thickness of 2 mm. There was also notion of minimally prominent intrahepatic biliary radicles seen within the CBD. Etiology workup of cholestatic transaminitis was negative. A diagnosis of immunotherapy related sclerosing cholangitis was posed and the patient was treated with MMF and prednisone with good response. Conclusions Discussion This patient seems to have developed immunotherapy mediated cholangitis. Liver biopsy when performed in liver injury tend to show lobular hepatitis, with liver parenchyma infiltrated with lymphocytes and focal necrosis with acidophilic bodies. However, there seems to be another, less frequent pattern of injury described with pembrolizumab and associated with cholangiopathy, resembling primary biliary cholangitis. It is characterized with portal tracts enlarged with fibrosis and inflammatory cells infiltration; infiltrating cells are lymphocytes (2). Biliary epithelium with fibrosis with CD8+ T cells infiltration seem to be recurrently reported in case reports. (3, 4). Other cases have been describe in the literature. In many cases, steroid therapy was attempted, but response rates seem to be inconsistent. Nivolumab related cholangitis have been also been described and characterized by extra hepatic bile duct dilatation along with negative immunological markers such as ANA and IgG4 in patients with non-small cell lung cancer, and seems to respond only moderately to steroid therapy (6). Retrospective data of nivolumab related cholangiopathy seems to suggest that there is favourable response to the combination of MMF and steroid therapy (7). Funding Agencies None

scholarly journals IgG4-related hepatic inflammatory pseudotumor with sclerosing cholangitis: a case report and review of the literature

Cases Journal ◽  
2009 ◽  
Vol 2 (1) ◽  
pp. 7029 ◽  
Author(s):  
Itaru Naitoh ◽  
Takahiro Nakazawa ◽  
Hirotaka Ohara ◽  
Tomoaki Ando ◽  
Kazuki Hayashi ◽  
...  
Keyword(s):  
Case Report ◽  
Sclerosing Cholangitis ◽  
Inflammatory Pseudotumor ◽  
Review Of The Literature ◽  
Hepatic Inflammatory Pseudotumor

Metronidazole ototoxicity - report of two cases

1999 ◽  
Vol 113 (4) ◽  
pp. 355-357 ◽  
Author(s):  
S. M. Iqbal ◽  
J. G. Murthy ◽  
P. K. Banerjee ◽  
K. A. Vishwanathan
Keyword(s):  
Hearing Loss ◽  
Case Report ◽  
Oral Administration ◽  
Sensorineural Hearing Loss ◽  
Steroid Therapy ◽  
World Literature ◽  
Sensorineural Hearing ◽  
Oral Steroid ◽  
The World ◽  
Oral Steroid Therapy

AbstractTwo cases of bilateral moderate to severe sensorineural hearing loss due to oral administration of metronidazole are reported. There has been only one case report of deafness following metronidazole therapy in the world literature. The hearing loss recovered gradually in a period of four to six weeks following withdrawal of drug and oral steroid therapy. The possible mechanism of ototoxicity is discussed. Awareness by the treating physician of ototoxicity due to any drug is stressed.

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