{
  "abstract": "We report a case of a man in his early 70s referred for Grade 2 immune checkpoint inhibitor induced liver injury (ChILI) post nivolumab and ipilimumab for metastatic melanoma. Despite treatment with immunosuppression, the liver enzymes improved but failed to normalise completely. Liver biopsy performed 6 months after diagnosis identified a severe hepatitis with interface and perivenular necroinflammatory activity. Mycophenolate was up-titrated to 1 g twice daily and prednisone 40 mg daily was commenced. Once liver enzymes normalised immunosuppression was then gradually withdrawn, with no recurrent elevation of the liver enzymes. This case demonstrates that there can be an incongruency between liver enzymes an histopathology in ChILI. As in our patient, this can have significant implications in managemen. Furthermore, this case is unique as there are no other reported cases in the literature of chronic ChILI.",
  "authors": [
    {
      "affiliations": [
        "Hepatology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia",
        "Liver Transplant Unit, Toronto General Hospital, Toronto, Ontario, Canada",
        "Hepatology, Toronto General Hospital, Toronto, Ontario, Canada"
      ],
      "name": "Chloe Attree"
    },
    {
      "affiliations": [
        "Division of Medical Oncology and Hematology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada"
      ],
      "name": "Samuel D. Saibil"
    },
    {
      "affiliations": [
        "Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Sandra Fischer"
    },
    {
      "affiliations": [
        "Hepatology, Toronto General Hospital, Toronto, Ontario, Canada"
      ],
      "name": "Morven Cunningham"
    }
  ],
  "title": "Discordance between biochemical and histological severity in persistent immune checkpoint inhibitor induced liver injury",
  "uid": "dcea442d-a578-57cf-a0fc-a4497a30ff46"
}