case_images: PMC11390286_01
case_images: Bilirubin trend for case 1. ICI-H: immune checkpoint inhibitor-induced hepatotoxicity
case_images: etat-05-1002250-g001.jpg
case_images: PMC11390286_01_etat-05-1002250-g001.jpg
case_images: fig1
case_images: Figure 1 charts the patient's bilirubin throughout their clinical course.
case_images: Representative imaging findings for included patients. (A) Case 1; cholangiographic image from magnetic resonance cholangiopancreatography (MRCP) on day 76 after diagnosis of immune checkpoint inhibitor-induced hepatotoxicity (ICI-H), demonstrating intrahepatic duct abnormalities consistent with sclerosing cholangitis; (B) case 1; cholangiographic image from MRCP on day 513, showing stable intrahepatic duct dilatation compared with prior imaging; (C) case 2; computed tomography (CT) image on day 206 after ICI-H diagnosis, demonstrating mild biliary dilatation; (D) case 2; T2 MR image on day 210, demonstrating more pronounced features of sclerosing cholangitis compared with Figure 2C; (E) case 2; cholangiographic image from MRCP on day 217, clearly demonstrating marked intrahepatic biliary dilatation, and a long segment of stenosis within the common bile duct (CBD); (F) case 3; CT image from 15 days before ICI-H diagnosis, demonstrating enhancement of the gallbladder, central bile ducts and CBD; (G) case 3; cholangiographic image from MRCP on day 26 after ICI-H diagnosis, demonstrating the same abnormalities as seen in Figure 2E, as well as intrahepatic duct abnormalities
case_images: etat-05-1002250-g002.jpg
case_images: PMC11390286_03_etat-05-1002250-g002.jpg
case_images: fig2
case_images: A routine CT scan 15 days before ICI-H was reported as showing pericholecystic haziness suggesting inflammation (Figure 2F; upon subsequent radiologist review for this case series, enhancement of the gallbladder, central bile ducts, and CBD were commented on). On day 29, MRCP showed dilated right peripheral bile ducts suggesting ICI-C (Figure 2G); the patient was accordingly commenced on MMF and 2 mg/kg IVMP, which was later (day 44) increased to 4 mg/kg and tacrolimus also commenced due to lack of LFT response.
case_images: PMC11390286_02
case_images: Representative imaging findings for included patients. (A) Case 1; cholangiographic image from magnetic resonance cholangiopancreatography (MRCP) on day 76 after diagnosis of immune checkpoint inhibitor-induced hepatotoxicity (ICI-H), demonstrating intrahepatic duct abnormalities consistent with sclerosing cholangitis; (B) case 1; cholangiographic image from MRCP on day 513, showing stable intrahepatic duct dilatation compared with prior imaging; (C) case 2; computed tomography (CT) image on day 206 after ICI-H diagnosis, demonstrating mild biliary dilatation; (D) case 2; T2 MR image on day 210, demonstrating more pronounced features of sclerosing cholangitis compared with Figure 2C; (E) case 2; cholangiographic image from MRCP on day 217, clearly demonstrating marked intrahepatic biliary dilatation, and a long segment of stenosis within the common bile duct (CBD); (F) case 3; CT image from 15 days before ICI-H diagnosis, demonstrating enhancement of the gallbladder, central bile ducts and CBD; (G) case 3; cholangiographic image from MRCP on day 26 after ICI-H diagnosis, demonstrating the same abnormalities as seen in Figure 2E, as well as intrahepatic duct abnormalities
case_images: etat-05-1002250-g002.jpg
case_images: PMC11390286_03_etat-05-1002250-g002.jpg
case_images: fig2
case_images: A routine CT scan 15 days before ICI-H was reported as showing pericholecystic haziness suggesting inflammation (Figure 2F; upon subsequent radiologist review for this case series, enhancement of the gallbladder, central bile ducts, and CBD were commented on). On day 29, MRCP showed dilated right peripheral bile ducts suggesting ICI-C (Figure 2G); the patient was accordingly commenced on MMF and 2 mg/kg IVMP, which was later (day 44) increased to 4 mg/kg and tacrolimus also commenced due to lack of LFT response.
case_images: PMC11390286_03
case_images: Representative imaging findings for included patients. (A) Case 1; cholangiographic image from magnetic resonance cholangiopancreatography (MRCP) on day 76 after diagnosis of immune checkpoint inhibitor-induced hepatotoxicity (ICI-H), demonstrating intrahepatic duct abnormalities consistent with sclerosing cholangitis; (B) case 1; cholangiographic image from MRCP on day 513, showing stable intrahepatic duct dilatation compared with prior imaging; (C) case 2; computed tomography (CT) image on day 206 after ICI-H diagnosis, demonstrating mild biliary dilatation; (D) case 2; T2 MR image on day 210, demonstrating more pronounced features of sclerosing cholangitis compared with Figure 2C; (E) case 2; cholangiographic image from MRCP on day 217, clearly demonstrating marked intrahepatic biliary dilatation, and a long segment of stenosis within the common bile duct (CBD); (F) case 3; CT image from 15 days before ICI-H diagnosis, demonstrating enhancement of the gallbladder, central bile ducts and CBD; (G) case 3; cholangiographic image from MRCP on day 26 after ICI-H diagnosis, demonstrating the same abnormalities as seen in Figure 2E, as well as intrahepatic duct abnormalities
case_images: etat-05-1002250-g002.jpg
case_images: PMC11390286_03_etat-05-1002250-g002.jpg
case_images: fig2
case_images: A routine CT scan 15 days before ICI-H was reported as showing pericholecystic haziness suggesting inflammation (Figure 2F; upon subsequent radiologist review for this case series, enhancement of the gallbladder, central bile ducts, and CBD were commented on). On day 29, MRCP showed dilated right peripheral bile ducts suggesting ICI-C (Figure 2G); the patient was accordingly commenced on MMF and 2 mg/kg IVMP, which was later (day 44) increased to 4 mg/kg and tacrolimus also commenced due to lack of LFT response.