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Adverse drug reactions
Severe hepatitis related to immune-checkpoint inhibitor in a patient with non-small-cell lung cancer and pulmonary tuberculosis
  1. Chuan-Yen Sun1,
  2. Chia-I Shen1,
  3. Jia-Yih Feng1,
  4. Chi-Lu Chiang1,2
  1. 1 Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
  2. 2 Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
  1. Correspondence to Chi-Lu Chiang, Division of Thoracic Oncology, Department of Chest Medicine, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei, Taiwan;clchiang{at}vghtpe.gov.tw

http://dx.doi.org/10.1136/postgradmedj-2020-138123

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    CASE PRESENTATION

    A 72-year-old male heavy smoker was diagnosed with stage IV non-small-cell lung cancer (NSCLC) with lung-to-lung metastasis. No druggable driver mutation was found and the tumour proportion score for programmed death (PD)-ligand 1 expression was 100% (Dako 22C3 assay). The result of sputum acid-fast staining, performed 1 month after the diagnosis, was positive. After confirmation by PCR (DR. MTBC ScreenTM IVD Kit), isoniazid, rifampin, ethambutol and pyrazinamide were administered for pulmonary tuberculosis (TB). A viral hepatitis panel performed before the administration of the anti-TB agents was negative for hepatitis B virus and hepatitis C virus infections. The patient’s liver enzyme levels were within the normal ranges before anti-TB agents, during anti-TB treatment and before immune-checkpoint inhibitor (ICI) treatment. Pembrolizumab monotherapy was administered 1 month after the administration of the anti-TB agents and sputum conversion. Unfortunately, the …

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    Footnotes

    • Contributors Conception and design of study: CLC. Acquisition of data: CYS. Drafting the manuscript: CYS, CIS. Revising the manuscript critically for important intellectual content: JYF, CLC. Approval of the version of the manuscript to be published: All authors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests CLC received honoraria from AstraZeneca, Boehringer Ingelheim, Roche and Merck Sharp & Dohme.

    • Patient consent for publication Consent obtained directly from patient(s).

    • Provenance and peer review Not commissioned; externally peer reviewed.