ArticleCureus2026
Optimal Corticosteroid Therapy Based on Liver Biopsy for Severe Immune-Mediated Hepatitis During Pembrolizumab Treatment: A Case Report.
Article in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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5 authors.
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Abstract
Immune checkpoint inhibitors (ICIs), including pembrolizumab, are widely used to treat advanced non-small cell lung cancer; however, they are associated with immune-related adverse events, including immune-mediated hepatitis. Although systemic corticosteroids are recommended as first-line therapy for severe immune-mediated hepatitis, the optimal initial dose remains unclear, and current guidelines specify a wide range of doses. Herein, we report the case of a 76-year-old man with lung adenocarcinoma, a history of resolved hepatitis B virus infection, ulcerative colitis in long-term remission, and latent hereditary spherocytosis who developed grade 3 immune-mediated hepatitis during pembrolizumab monotherapy. Liver biopsy revealed moderate lobular necroinflammation consistent with immune-mediated hepatitis. Based on these histopathological findings, prednisolone at 0.3 mg/kg/day was initiated. Liver enzyme levels improved rapidly, and pembrolizumab was subsequently resumed without recurrence of immune-mediated hepatitis. This case highlights the diagnostic and therapeutic value of liver biopsy in patients with severe immune-mediated hepatitis. Histopathological assessment of inflammatory severity and bile duct involvement may contribute to individualized corticosteroid dosing, promote early recovery, and support safe ICI rechallenge.
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