Severe hepatitis related to immune-checkpoint inhibitor in a patient with non-small-cell lung cancer and pulmonary tuberculosis

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 …