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Case Reports
. 2023 Aug 14:10:1231597.
doi: 10.3389/fmed.2023.1231597. eCollection 2023.

Fatal acute-on-chronic liver failure following camrelizumab for hepatocellular carcinoma with HBsAg seroclearance: a case report and literature review

Fenghui Li  1 , Tao Wang  1 , Fei Tang  1 , Jing Liang  1
Affiliations
Case Reports

Fatal acute-on-chronic liver failure following camrelizumab for hepatocellular carcinoma with HBsAg seroclearance: a case report and literature review

Fenghui Li et al. Front Med (Lausanne). .

Abstract

In the last few years, immune checkpoint inhibitors (ICIs) have become major therapeutic agents for the treatment of advanced hepatocellular carcinoma (HCC). However, immunotherapy can activate hepatitis B virus (HBV), and immune clearance may lead to liver failure and even life-threatening conditions. Here we report a case of HCC with HBV-related cirrhosis that caused severe liver injury and rapidly progressed to fatal acute-on-chronic liver failure (ACLF) after only once application of camrelizumab; the patient underwent serological conversion of hepatitis B surface antigen (HBsAg) with liver injury. The patient's condition progressed rapidly. We added corticosteroids and applied plasma dialysis, along with tenofovir alafenamide (TAF) to control HBV. However, the patient eventually died of liver failure. To our knowledge, there are few reports of HBsAg clearance due to ICIs accompanied by fatal acute-on-chronic liver failure shortly after ICIs initiation. These results suggest that ICIs can cause fatal liver injury in a short term; in patients with chronic HBV infection, ICIs use may promote serological conversion of HBsAg.

Keywords: clearance of HBsAg; hepatitis B; immune checkpoint inhibitors (ICIs); immune-mediated liver injury caused by checkpoint inhibitors (ILICI); liver failure.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Contrast-enhanced ultrasound (CEUS) images and digital subtraction arteriogram (DSA) during TACE (A) CEUS in the arterial phase shows hyperenhancement of the mass [(A) arrow]; (B) The mass shows washout in the portal venous phase of CEUS [(B) arrow]; (C) pre-embolization DSA of the mass, black arrow represents tumor blush; (D) post-embolization DSA was repeated and demonstrated no residual enhancing tumor.
Figure 2
Figure 2
Abdominal enhanced computed tomography images (A) Plain CT scan; (B) arterial phase of contrast-enhanced CT; (C) portal vein phase of contrast-enhanced CT. CT examination of the abdomen show no biliary obstruction and disease progression of intrahepatic lesions.
Figure 3
Figure 3
Changes of various indicators after hospitalization. (A–C) Trend of clinical indicators; (D) trend of severity scores.
See this image and copyright information in PMC

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