Immune Checkpoint Inhibitors-Induced Hepatitis

Immune checkpoint inhibitors (ICIs) have been increasingly used for multiple cancer types in the past decade. ICIs include CTLA-4 inhibitors (e.g., ipilimumab) and the PD-1 and PD-L1 inhibitors (e.g., nivolumab and pembrolizumab). Hepatotoxicity is not uncommon secondary to ICI treatment. It can occur 8-12 weeks after the initiation of ICI and presents with elevation of aspartate transaminase and alanine transaminase. ICI-induced hepatitis is usually asymptomatic but may present with fever, malaise, and even death in rare cases. It is a diagnosis of exclusion after other etiologies are excluded based on medical history, laboratory evaluation, and imaging and histological findings. ICI-induced hepatitis might require discontinuation of ICI and/or treatment with immunosuppressants.