case_images: PMC9851788_01
case_images: Timeline with dose of immunosuppressants and events. Target trough levels of tacrolimus and everolimus were 7-8 mug/L and 6-8 mug/L, respectively, with blue coloring for subtherapeutic levels, green for therapeutic levels, and red for supratherapeutic levels. Abbreviations: dMMR = deficient mismatch repair; i.v. = intravenous; mCC = metastatic colon cancer; MFA = mycophenolate; MPA = mycophenolic acid; MSI = microsatellite instability; mTOR = mechanistic target of rapamycin; WHO PS = World Health Organization performance score.
case_images: CRIT2023-9643370.001.jpg
case_images: PMC9851788_01_CRIT2023-9643370.001.jpg
case_images: fig1
case_images: Prednisone was increased for symptom relief, and other immunosuppressants were continued.  Figure 1 presents a timeline with dose of immunosuppressant and events.
case_images: CT-imaging with measurement of lesions in liver segments II and VI and approximate liver tumor involvement. Abbreviations: CT = computerized tomography.
case_images: CRIT2023-9643370.002.jpg
case_images: PMC9851788_01_CRIT2023-9643370.002.jpg
case_images: fig2
case_images: Her performance status had unexpectedly improved, and CT imaging showed reduction of the colon cancer liver metastases (Figure 2).
case_images: Histopathology of primary tumor and liver metastases. H&E staining of liver and colon sections (a-c). Liver biopsy sections with an asterisk showing colorectal metastasis and a circle showing preexistent liver tissue (a), liver obduction sections with a square showing necrosis and a triangle showing fibrosis (b), and colon carcinoma obduction sections with an asterisk showing colon tumor tissue (c). CD3+ staining of liver and colon sections (d-f). Liver biopsy sections, liver obduction sections, and colon obduction sections all show a sparse lymphocytic T-cell infiltrate. Magnification of (a), (b), (d), and (e) is 25x and (c) and (f) is 20x.
case_images: CRIT2023-9643370.003.jpg
case_images: PMC9851788_01_CRIT2023-9643370.003.jpg
case_images: fig3
case_images: Lymphocytic infiltrate was scarce in both the primary tumor as in the necrotic/fibrotic liver lesions with some CD3+ cells, a slight number of CD8+ cells, and only a few positive cells with granzyme B staining (Figure 3). In the necrotic lever lesions, no vital tumor cells were present (Figure 3).